Increase in splenic volume suggesting unrecognized portal hypertension resulting from adjuvant FOLFOX chemotherapy in colorectal cancer (CRC)

Abstract

15028 Background: FOLFOX has been associated with pathological hepatic injury. The impact of adjuvant chemotherapy on portal hypertension and splenic enlargement has not been previously described. We conducted a retrospective study to assess the effects of adjuvant FOLFOX chemotherapy on splenic volume as a surrogate marker for portal hypertension. Methods: CRC pts treated with adjuvant FOLFOX chemotherapy at Roswell Park Cancer Institute between2002 and 2006were identified. Demographic, body mass index (BMI), serial alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) data were collected. Serial computerized tomography (CT) data starting prior to chemotherapy, at the completion of chemotherapy, and every 6 months thereafter were reviewed. Splenic size (measured as splenic index [SI] = length × width × height of the spleen), and portal vein measurements were collected. Correlations between SI, time from treatment, and other variables were investigated. Wilcoxon and Fisher's exact tests were used for association analysis (0.05 significance level). Results: 40 ptswere identified. The mean SI was 522, 734, 633, 631, 576 cm3, at baseline, 6, 12, 18, and 24 months (m), respectively. SI was increased ≥ 50% in 15 pts (37%) and 5 pts (13%) at 6 and 12 m from baseline, respectively. SI was increased by ≥ 25% in 22 pts (55%) and 12 pts (32%) at 6 and 12 m from baseline, respectively. The mean increase in SI from baseline was 46%, 25%, 20%, 17% at 6, 12, 18, and 24 m from baseline, respectively. SI decreased with time upon completion of chemotherapy (p = 0.0043). One pt has progressive increase in SI > 1 year from completion of chemotherapy. There was a significant baseline splenic index effect, with higher baseline SI being associated with an increased likelihood of splenic enlargement (p < 0.0001). There was no correlation between BMI, ALT, AST, or ALP and SI. Portal vein diameter and SI had significant positive correlation at 6 m in patients with a SI increase ≥25%. Conclusions: Splenic enlargement is common upon completion of adjuvant FOLFOX chemotherapy, is reversible in the majority of patients, and has no clear clinical significance. No significant financial relationships to disclose.