In the present study, including the FOLFOX/BEV and XELOX/BEV regimens, we found that an APR before chemotherapy of ≥0.15 can significantly predict the development of adverse events during chemotherapy. Therefore, an APR of ≥0.15 before

chemotherapy can be a valuable indicator of whether or not oxaliplatin-based preoperative chemotherapy including BEV should be administered to patients with initially resectable disease when the indication is considered based on the risk of adverse events. The management of chemotherapy-associated hepatotoxicity is now considered an important issue (7,17) because chemotherapy-associated hepatotoxicity can be an important risk factor for postoperative complications, especially Inhibitors,research,lifescience,medical hepatic insufficiency, after a major hepatectomy (9,13). Inhibitors,research,lifescience,medical In addition, sinusoidal obstruction syndrome due to oxaliplatin-based chemotherapy may not only compromise the perioperative outcome, but can lead to early recurrence and decreased survival in the long term (18). However,

it is still unclear in which cases chemotherapy-associated hepatotoxicity will occur. We previously reported that an indocyanine green retention test, AST before hepatectomy, and completion of six or more cycles of FOLFOX could predict the presence of histopathologic sinusoidal obstruction syndrome (9). Recently, Inhibitors,research,lifescience,medical the possible development of splenomegaly and thrombocytopenia induced by portal hypertension due to chemotherapy was reported, and the authors showed that adjuvant FOLFOX significantly increased the SVI in patients with stage II or III colorectal cancer. They suggested that splenomegaly and thrombocytopenia were useful indicators of the presence of chemotherapy-associated

liver injury Inhibitors,research,lifescience,medical (10,11). Our previous study also highlighted the risk of oxaliplatin–induced splenomegaly in patients receiving Inhibitors,research,lifescience,medical FOLFOX (15). Bevacizumab is now an important component of the treatment for metastatic colorectal cancer, because it improves the chemotherapeutic response and progression-free survival of patients (2,19,20). Overman et al. recently reported that the LY2603618 order addition of bevacizumab to oxaliplatin-based chemotherapy reduces the incidence of splenomegaly (11). We previously reported that the SVI was +19.1% in patients treated with FOLFOX (15). Interestingly, in the FOLFOX/BEV group in the present study, the SVI was +5.0% in the FOLFOX/BEV group, confirming 4-Aminobutyrate aminotransferase the finding reported by Overman et al. They also reported that there was a decreased rate of thrombocytopenia in patients treated with the BEV regimens, and a tendency for this phenomenon was also noticed in our study (149/mm3 in the FOLFOX (15) and 164/mm3 in the FOLFOX/BEV groups, P=0.14, not shown in the Results section). However, no previous study had focused on the SVI in patients receiving the XELOX/BEV regimen. The present study cannot explain why the SVI was significantly higher in the XELOX/BEV group than in the FOLFOX/BEV. Cassidy et al.