By Sharan Sharma

Increase in spleen size can be used to correlate the incidence of hepatic sinusoidal injury and subsequent portal hypertension in patients using oxaliplatin-based chemotherapy, according to a study published in the Journal of Clinical Oncology, May 20 issue.

Oxaliplatin-based chemotherapy is now routinely used in patients with colorectal cancer in both adjuvant and metastatic settings. It is also used before the resection of hepatic metastasis. First, reported in 2004 sinusoidal injuries due to oxaliplatin have been subsequently documented in many studies.

Researchers from MD Anderson Cancer Center, USA and the Centro Oncologico de Hospital Sirio-Libanes, Brazil retrospectively analysed chemotherapy exposure, changes in spleen size and platelet counts in 136 colorectal patients who were treated with flourouracil plus oxaliplatin and fluoropyrimidine alone. The researchers found that spleen size increased in 86% of patients treated with fluorouracil and oxaliplatin group (p<0.001). In 24% of those patients spleens were shown to increase by 50%. However, spleen size did not significantly increase in patients treated with fluoropyrimidine. Patients who had 50% increase in spleen size were more likely to have higher rates of thrombocytopenia in the first year after completion of chemotherapy. In patients with hepatic metastases treated with preoperative fluoropyrimidine and oxaliplatin, an increase in spleen size was a predictor of higher histologic grades of sinusoidal injury in both univariate (P = .03) and multivariate (P = .02) analyses.

The authors note "These results suggest that increases in splenic size may serve as a potential biomarker for predicting hepatic sinusoidal injury". About the implication of the study the authors point "Patients noted to have a 50% increase in spleen size before planned hepatic resection appear to be at high risk for sinusoidal injury and could be considered for preoperative percutaneous liver biopsy to assess the magnitude of hepatic sinusoidal injury, or for portal venous cannulation to assess the regenerative capacity of the liver".