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Published on: July 31, 2016
Hepatic Artery Infusion Pump Chemotherapy Associated Biliary Sclerosis After Treatment for Colorectal Cancer Liver
Ankur P Choubey1, Kenneth Seier2, Lauren Schleimer1
1Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Insights
Hepatic artery infusion pump chemotherapy (HAIC) for colorectal liver metastasis (CRLM) has a 6% risk of biliary sclerosis (BS) within 60 months. Increased cumulative floxuridine dose and HAIC cycles independently raise BS risk.
Area of Science:
- Oncology
- Gastroenterology
- Chemotherapy Research
Background:
- Hepatic artery infusion pump chemotherapy (HAIC) is used for colorectal liver metastasis (CRLM).
- Biliary sclerosis (BS) is a significant complication of HAIC for CRLM.
- This study investigates the incidence and risk factors of BS following HAIC for CRLM.
Purpose of the Study:
- To determine the incidence of biliary sclerosis (BS) after HAIC for CRLM.
- To identify risk factors associated with BS development in patients undergoing HAIC for CRLM.
- To evaluate BS incidence in both adjuvant and unresectable CRLM settings.
Main Methods:
- Retrospective analysis of 2239 CRLM patients treated with floxuridine via HAIC (2000-2022).
- Primary outcome: BS, defined as intractable hyperbilirubinemia or biliary stricture requiring intervention.
- Competing risk analysis used, with death as the competing event.
Main Results:
- The 60-month incidence of BS was 6% (128 events), with no significant difference between adjuvant and unresectable CRLM groups.
- Neither operative variables nor hepatic arterial anatomy influenced BS risk.
- Increased BS risk was independently associated with higher cumulative floxuridine dose and more HAIC cycles in both adjuvant and unresectable CRLM patients.
Conclusions:
- The overall incidence of BS after HAIC for CRLM is 6% at 60 months.
- Cumulative floxuridine dose and the number of HAIC cycles are independent risk factors for BS.
- BS risk did not differ between adjuvant and unresectable CRLM groups, likely due to survival differences.
Background:
Hepatic artery infusion pump chemotherapy (HAIC) improves colorectal liver metastasis (CRLM) outcomes, but treatment-associated biliary sclerosis (BS) is a major complication. This study evaluates the incidence of and risk factors for BS after HAIC for CRLM.
Methods:
This was a single-center retrospective analysis including all patients with CRLM treated with floxuridine between 2000 and 2022. The primary outcome was BS, intractable hyperbilirubinemia, and/or biliary stricture not caused by cancer progression requiring percutaneous or endoscopic stenting or drainage. BS was analyzed using competing risk methods where death was the competing event.
Results:
Between 2000 and 2022, a total of 2239 patients received HAIC for CRLM, 48% (n=1067) received adjuvant HAIC and 52% (n=1172) were unresectable. There were 128 (6% at 60 months) BS events, and rates did not differ between adjuvant (n=66) and unresectable (n=62) groups (60-month estimate: 6% [95% confidence interval (CI) 5-8] vs 6% [95% CI 4-7]; p=0.362). Operative variables, variant hepatic arterial anatomy, non-gastroduodenal artery cannulation, and extrahepatic perfusion were not associated with BS. In adjuvant cases, BS risk increased with each cycle (hazard ratio [HR] 1.123, p=0.003) and every 100 mg of cumulative floxuridine (HR 1.087, p<0.001) controlling for concurrent colorectal resection and variant vessel ligation. Among unresectable patients, each cycle (HR 1.087, p<0.001) and every 100 mg of cumulative floxuridine (HR 1.054, p<0.001) increased BS risk, controlling for race and concurrent colorectal resection.
Conclusions:
The incidence of BS after HAIC for CRLM is 6% after 60 months and does not differ in the adjuvant and unresectable setting due to meaningful differences in survival. Cumulative floxuridine dose and number of HAIC cycles were independently associated with increased BS risk.
