Impact of chemotherapy-associated liver injury on tumour regression grade and survival in patients with colorectal liver metastases

Abstract Background An inverse relation between chemotherapy-associated liver injury (CALI) and tumour response to chemotherapy has been reported. The aim was to validate these findings, and further investigate the impact of CALI on survival in patients who underwent partial hepatectomy for colorectal liver metastases (CRLM). Methods Patients who received neoadjuvant chemotherapy and underwent partial hepatectomy for CRLM between 2008 and 2014 were included. Liver and tumour specimens were histologically examined for CALI (steatosis, steatohepatitis, sinusoidal dilatation [SD], nodular regeneration) and tumour regression grade (TRG). TRG 1–2 was defined as complete tumour response. Results 166 consecutive patients were included with a median survival of 30 and 44 months for recurrence-free and overall survival, respectively. Grade 2–3 SD was found in 44 (27%) and TRG 1–2 was observed in 33 (20%) patients. Of studied CALI, only grade 2–3 SD was associated with increased TRG 3–5 (odds ratio 3.99, 95% CI 1.17–13.65, p  = 0.027). CALI was not significantly related to survival. TRG 1–2 was associated with prolonged recurrence-free (hazard ratio 0.47, 95% CI 0.25–0.89, p  = 0.020) and overall survival (hazard ratio 0.35, 95% CI 0.18–0.68, p  = 0.002). Conclusion CALI was not directly related to survival. CALI was, however, associated with diminished complete tumour response, and diminished complete tumour response, in turn, was associated with decreased survival.