The incidence of splenomegaly due to oxaliplatin treatment in patients with stage 2-3 colorectal cancer and its relationship with clinical and laboratory parameters

Introduction: Colorectal cancers are the third most common type of cancer among cancer types. It has been shown that receiving chemotherapy at a sufficient dose reduces cancer recurrence. For various reasons, the treatment dose may be reduced or the treatment may be interrupted in patients receiving chemotherapy. It has been demonstrated that splenomegaly can develop during oxaliplatin treatment. In this study, we aimed to investigate changes in the volume of the spleen, along with clinical and blood parameters, and their impact on antineoplastic treatments in patients undergoing oxaliplatin-based chemotherapy. Methods: Our retrospective study included 75 patients diagnosed with colorectal cancer. The study involved patients aged 18 and older who received adjuvant FOLFOX or CAPOX chemotherapy. Patients with a history of splenectomy, liver cirrhosis, active viral hepatitis, non-cirrhotic portal hypertension, and hematological diseases were excluded. Computed tomography data of patients during diagnosis and follow-up were reviewed by a radiologist. A 30% increase in spleen volume compared to the baseline after chemotherapy was considered as splenomegaly. The relationship between the development of splenomegaly in patients and laboratory data, the doses of oxaliplatin received, histopathological data, comorbidities, and chemotherapy regimen were investigated. Results: At the 6th month of follow-up, splenomegaly was observed in 43 patients, while it was not observed in 32 patients. The location of the tumor, body surface area of the patient, gender, age, tumor grade, LVI, PNI, disease stage, Tumor T stage, Tumor N stage, comorbid conditions, and laboratory data were found to have no relationship with splenomegaly. In correlation tests, splenomegaly was found to have a negative correlation with thrombocytopenia (r= -0.221; p=0.050), while splenomegaly had a positive correlation with the total oxaliplatin dose (r= 0.225; p=0.050). The average oxaliplatin dose was higher in patients who developed splenomegaly (p=0.151). 38 patients received CAPOX, and 37 patients received FOLFOX treatment. There was no significant difference between FOLFOX and CAPOX treatments in terms of the rate of developing splenomegaly (p=0.404). The rate of dose reduction in FOLFOX-treated patients was significantly higher compared to those receiving CAPOX (p=0.007). Conclusion: Splenomegaly is a clinical condition that can cause cytopenia and may occur as a result of chemotherapy. In colorectal cancers, the oxaliplatin-induced enlargement of the spleen should be considered as a potential etiology for thrombocytopenia in the aftermath of oxaliplatin treatment.