Clinical characteristics and efficacy of endoscopic treatment in oxaliplatin-associated portal hypertension
10.3760/cma.j.cn311367-20240523-00208
- VernacularTitle:奥沙利铂相关门静脉高压的临床特征和内镜治疗效果
- Author:
Liyuan NI
1
;
Xiaoquan HUANG
;
Siyu JIANG
;
Yingjie AI
;
Ling WU
;
Shiyao CHEN
Author Information
1. 复旦大学附属中山医院消化科，上海 200032
- Publication Type:Journal Article
- Keywords:
Portal hypertension;
Esophagogastric variceal bleeding;
Oxaliplatin;
Endoscopic treatment
- From:
Chinese Journal of Digestion
2024;44(11):744-750
- CountryChina
- Language:Chinese
-
Abstract:
Objective:A cohort of patients with oxaliplatin-associated portal hypertension was established and compared with patients with hepatitis B or schistosomiasis-associated cirrhotic portal hypertension to explore the course, disease features and prognosis of endoscopic treatment.Methods:From January 1, 2014 to December 31, 2021, patients diagnosed with portal hypertension and gastroesophageal varices after oxaliplatin chemotherapy at Zhongshan Hospital of Fudan University were selected (oxaliplatin general group). The patients who received endoscopic treatment for the first time because of esophagogastric variceal bleeding in the oxaliplatin general group were included in the oxaliplatin group. From January 1, 2014 to December 31, 2016, patients who initially received endoscopic treatment for the first time because of esophagogastric variceal bleeding due to hepatitis B or schistosomiasis-associated cirrhotic portal hypertension at Zhongshan Hospital of Fudan University were enrolled (hepatitis B group and schistosomiasis group). The history of oncology and chemotherapy, laboratory results, imaging and pathological findings were collected, and the clinical features were analyzed. Clinical data were collected, and the clinical features, 3-year cumulative non-bleeding rate and survival rate after endoscopic treatment of the 3 groups including oxaliplatin group, hepatitis B group and schistosomiasis group were compared. Kaplan-Meier survival curve was drawn to estimate treatment effects, and log-rank method was performed to test the differences in survival curves. Chi-square test and Mann-Whitney U test were used for statistical analysis. Results:There were 93 patients in oxaliplatin general group, with a median chemotherapy course of 8 (ranged from 6 to 10) cycles, and the median time from the end of chemotherapy to the diagnosis of gastroesophageal varices was 4 (ranged from 2 to 6) years. There were 55 patients in oxaliplatin group, 191 cases in hepatitis B group and 96 cases in schistosomiasis group. There were 78.5% (73/93) of patients in the oxaliplatin group classified as Child-Pugh grade A, and 33 patients (35.5%) with portal vein thrombosis. The abdominal imaging showed no obvious liver cirrhosis such as liver shrinkage and uneven surface. The pathology of 11 patients with liver biopsy in the oxaliplatin general group showed mainly vascular injury and fibrous deposition in the confluent area with lymphocytic infiltration, mild hepatocellular injury, and no pseudolobule formation. In terms of baseline characteristics, direct bilirubin, alanine transaminase, and aspartate transaminase levels of patients in the oxaliplatin group were all lower than those of the hepatitis B group and schistosomiasis group (4.8 (3.9, 6.5) μmol/L vs. 6.4 (4.7, 9.0) and 6.5 (4.4, 9.4) μmol/L; 17 (13, 22) U/L vs. 22 (15, 31) and 19 (15, 27) U/L; 22 (19, 25) U/L vs. 28 (22, 39) and 29 (22, 42) U/L), while albumin and prealbumin levels and the proportion of patients with Child-Pugh grade A were all higher than those of the hepatitis B group and schistosomiasis group (39.0 (35.0, 42.5) g/L vs. 34.0 (30.0, 38.3) and 33.8 (29.5, 36.0) g/L; 0.160 (0.130, 0.197) g/L vs. 0.120 (0.090, 0.150) and 0.110 (0.080, 0.140) g/L; 74.5% (41/55) vs. 55.5% (106/191) and 42.7% (41/96)), and the differences were all statistically significant ( U=3 298.50, 2 749.00, 2 159.00, 7 759.00, 5 822.50, χ2=6.92 and U=1 622.00, 1 878.50, 1 305.50, 3 989.00, 3 264.50, χ2=16.36; all P<0.05). The 3-year rebleeding risk in the oxaliplatin group was higher than that in the hepatitis B group ( HR=1.80, 95% confidence interval 1.07 to 3.02, P=0.026), but the difference was not statistically significant compared with that of the schistosomiasis group ( HR=1.04, 95% confidence interval 0.61 to 1.78, P=0.874). There were no statistically significant differences in the 3-year cumulative survival rate between the oxaliplatin group and the hepatitis B group and schistosomiasis group (96.4% (53/55) vs. 94.8% (181/191) and 95.8% (92/96), both P>0.05). Conclusions:The pathology of liver injury in patients with oxaliplatin-associated portal hypertension are mainly vascular injury and fibrous deposition in the confluent area. The efficacy of endoscopic treatment to prevent rebleeding in patients with oxaliplatin-associated portal hypertension is significantly inferior to that in patients with hepatitis B-associated portal hypertension, but comparable to that in patients with schistosomiasis-associated portal hypertension.
