Warren H W, Gallagher H, Hemingway D M, Angerson W J, Bessent R G, Wotherspoon H, McArdle C S, Cooke T G
Department of Surgery, Queen Elizabeth Hospital, King's Lynn, UK.
Br J Surg. 1998 Dec;85(12):1708-12. doi: 10.1046/j.1365-2168.1998.00975.x.
This prospective study was designed to test the hypothesis that abnormal liver blood flow is related to poor prognosis in patients with colorectal cancer.
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.
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 recurrence 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)).
The HPI predicts a poor outcome in patients with colorectal cancer and may be useful in patient selection for adjuvant chemotherapy.
本前瞻性研究旨在验证结直肠癌患者肝血流异常与预后不良相关这一假说。
对202例结直肠癌患者采用动态肝脏闪烁扫描测定肝灌注指数（HPI）。对明显肝转移的评估包括剖腹手术时肝脏触诊及围手术期计算机断层扫描（CT）。在专门诊所进行的随访包括定期腹部超声检查和CT检查。
105例有明显肝转移的患者中，92例（88%）的HPI异常（大于0.37）。89例初次切除后无明显转移或残留肿瘤证据的患者中，52例HPI异常，37例HPI正常。中位随访39（13 - 76）个月，38例复发患者中有25例HPI异常。45例死亡患者中约31例HPI异常。HPI可预测总体复发（P = 0.04，对数秩检验）。多变量分析显示，HPI在预测无病生存方面独立于Dukes分期（P = 0.04，相对风险1.94（95%置信区间（c.i.）1.03 - 3.67）），但在预测总生存方面未达到显著意义（P = 0.055，相对风险1.88（95% c.i. 1.00 - 3.58））。
HPI可预测结直肠癌患者的不良预后，可能有助于辅助化疗患者的选择。
