Obesity rather than neoadjuvant chemotherapy predicts steatohepatitis in patients with colorectal metastasis

Neoadjuvant chemotherapy has been associated with an increased risk of surgery because of chemotherapy-associated steatohepatitis and sinusoidal obstruction. The aim of the current study was to assess for other predictors of steatohepatitis and sinusoidal obstruction and to determine the role of obesity as a risk factor in patients with colorectal liver metastasis (CLM).

An institutional review board-approved prospectively maintained database of 1,605 patients who underwent hepatic procedures for CLM from 2001 to 2009 was reviewed.

In a review of 208 resected patients, body mass index was the only predictor of liver injury according to multivariate analysis (P < .001, odds ratio = 3.88). Diabetes, neoadjuvant chemotherapy, sleep apnea, alcohol use, tobacco use, age, and sex were not significant predictors. Among preoperative chemotherapy patients, BMI was a predictor of chemotherapy liver injury according to multivariate analysis (P < .0001). The rate of obesity (BMI >30) was 36%, and among obese patients (BMI >30) the rate of steatosis or steatohepatitis was 39%.

Obesity is the strongest predictor of steatosis and steatohepatitis in patients with CLM, and this risk is independent of the use of preoperative chemotherapy.