title: Prospective assessment of the hepatic perfusion index in patients with colorectal cancer.
abstract: 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 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)).
  
  
  CONCLUSIONS
  The HPI predicts a poor outcome in patients with colorectal cancer and may be useful in patient selection for adjuvant chemotherapy.
authors.affiliation: Department of Surgery, Queen Elizabeth Hospital, King's Lynn, UK.
authors.forename: H W
authors.initials: HW
authors.lastname: Warren
authors.forename: H
authors.initials: H
authors.lastname: Gallagher
authors.forename: D M
authors.initials: DM
authors.lastname: Hemingway
authors.forename: W J
authors.initials: WJ
authors.lastname: Angerson
authors.forename: R G
authors.initials: RG
authors.lastname: Bessent
authors.forename: H
authors.initials: H
authors.lastname: Wotherspoon
authors.forename: C S
authors.initials: CS
authors.lastname: McArdle
authors.forename: T G
authors.initials: TG
authors.lastname: Cooke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008102:Liver Circulation / Q000502:physiology*; D008113:Liver Neoplasms / Q000098:blood supply / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods