Prospective assessment of the hepatic perfusion index in patients with colorectal cancer

• Published in: British journal of surgery Vol. 85; no. 12; pp. 1708 - 1712
• Main Authors: Warren, H. W., Gallagher, H., Hemingway, D. M., Angerson, W. J., Bessent, R. G., Wotherspoon, H., Mcardle, C. S., Cooke, T. G.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.12.1998; Wiley
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Colorectal Neoplasms - physiopathology; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Liver Circulation - physiology; Liver Neoplasms - blood supply; Liver Neoplasms - secondary; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local; Prognosis; Prospective Studies; Risk Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Survival Analysis; Tomography, X-Ray Computed - methods; Tumors; Radionuclide study; Human; Regional perfusion; Rectal disease; Liver; Exploration; Scintigraphy; Malignant tumor; Survival; Index (documentation); Colonic disease; Blood vessel; Rectum; Predictive value; Digestive diseases; Hemodynamics; Colon
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1046/j.1365-2168.1998.00975.x

Background This prospective study was designed to test the hypothesis that abnormal liver blood flow is related to poor prognosis in patients with colorectal cancer. Methods The hepatic perfusion index (HPI), measured by dynamic hepatic scintigraphy, was assessed in 202 patients with colorectal cancer. Assessment for overt hepatic metastasis included liver palpation at laparotomy and perioperative computed tomography (CT). Follow‐up at a dedicated clinic included regular abdominal ultrasonography and CT. Results The HPI was abnormal (greater than 0·37) in 92 (88 per cent) of 105 patients with overt liver metastases. Of 89 patients with no evidence of overt metastases or residual tumour after primary resection, 52 had an abnormal and 37 a normal HPI. At a median follow‐up of 39 (range 13–76) months, 25 of 38 patients with recurrnce had an abnormal HPI. Some 31 of 45 patients who died had an abnormal HPI. The HPI predicted overall recurrence (P = 0·04, log rank test). Multivariate analysis showed the HPI was independent of Dukes stage for predicting disease‐free survival (P = 0·04, relative risk 1·94 (95 per cent confidence interval (c.i.) 1·03–3·67)) but this just failed to attain significance for overall survival (P = 0·055, relative hazard 1·88 (95 per cent c.i. 1·00–3·58)). Conclusion The HPI predicts a poor outcome in patients with colorectal cancer and may be useful in patient selection for adjuvant chemotherapy. © 1998 British Journal of Surgery Society Ltd