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HEPATIC GLYCOGEN DEPLETION IS PREVALENT IN PATIENTS WITH METASTATIC COLORECTAL CANCER TO LIVER
Meng Liu
*, Xulang Zhang, Jing Zhou, Xin Wang, Hao Wang, Ankesh Nigam, Andrea Lightle, Hwa Jeong Lee
Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY
Background: Malnutrition in patients undergoing hepatic surgery can lead to adverse postoperative outcomes and increased healthcare costs. Thus, nutritional assessment is required before all hepatic surgery and pre-operative nutrition support is offered when necessary. Several nutritional screening tools have been validated. However, hepatic glycogen status, reflective of systemic nutritional status, has not been investigated. We studied the prevalence of glycogen depletion in patients with colorectal cancer and liver metastasis (CRLM) using resected liver tissue.
Design: Archived partial hepatectomies with CRLM (n=51) served as study group and were divided into group A (recent chemotherapy, <1 y of surgery; n=33) and B (no/remote chemotherapy; n=18). Partial hepatectomies without malignancy (trauma, focal nodular hyperplasia, etc; n=23) were used as controls (group C). Representative H&E sections showing benign background liver were assessed for steatosis and corresponding tissue blocks were subjected to PAS and PASD special stains. The hepatic parenchymal surface areas with cytoplasmic granular PAS staining (indicating glycogen reserve) that were digestible by diastase were quantified as percentages. 18 patients with high (?50%; n=9) and low (<50%; n=9) glycogen reserve in the benign background liver were further selected and representative tumor blocks showing tumor-liver interface were subjected to the same stains. Patient characteristics, pathologic and surgical outcome (death, hospital stay, infection, acute kidney injury, readmission, etc) data were collected from the medical records.
Results: Hepatic glycogen reserve was significantly lower in the study group than in the control group (mean 64% vs 91%; p=0.0003) (Figure 1), but no significant difference was noted between group A and B. The glycogen reserve in peritumoral liver was similar to that in benign background liver. 31.4% of study group patients showed low (<50%) glycogen reserve. Intratumoral glycogen reserve was negligible (<10% in 15/18). Glycogen reserve showed no association with body mass index (BMI), presurgical AST/ALT, serum albumin, or tumor size. Interestingly, glycogen reserve correlated positively with steatosis (r=0.33, p=0.018) and older age (r=0.35, p=0.013) in the study group, though these two factors did not correlate with each other. No difference in surgical outcomes was noted between CRLM patients with high (?50%) and low (<50%) glycogen reserve.
Conclusion: Hepatic glycogen depletion is prevalent in CRLM patients undergoing hepatic surgery, and it is not associated with history/recency of chemotherapy, BMI, tumor size, intratumoral glycogen reserve or surgical outcomes. Steatosis, measurable by imaging, and age did correlate with glycogen reserve and may serve as adjunct screening parameters for presurgical nutritional status evaluation in patients with CRLM.
Figure 1
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