Hepatic blood flow by perfusion computed tomography as an imaging biomarker for patients with gastric cancer

Abstract

Perfusion computed tomography (PCT) is a less invasive imaging modality that provides information about tissue hemodynamics at the capillary level. The present study aimed to investigate the correlation between hepatic perfusion and gastric cancer progression. A total of 136 patients with gastric adenocarcinoma were evaluated in the present study. Prior to initial treatment, liver PCT was performed across the hepatic hilar plane and the hepatic blood flow (HBF) was measured using the dual-input deconvolution method. HBF was compared with clinicopathological factors, patient prognosis and circulating serum proangiogenic cytokines. The median HBF was 217 ml/min/100 g tissue. Patients with high HBF had larger tumors (43 mm vs. 71, P<0.001) and more advanced tumor-node stages (P<0.001 for both). When both patient groups of operable and inoperable were compared by their respective median HBF values, each high-HBF group had a significantly worse prognosis (P=0.002 and P=0.024), notably in the inoperable group, with <1-year survival. In 17 postoperative recurrent patients, the high-HBF at recurrence group also had a significantly worse postrecurrent prognosis (P=0.019). HBF was an independent prognostic factor (hazard ratio, 2.019; P=0.048) and was strongly associated with serum vascular endothelial growth factor level (R=0.607, P<0.001). HBF was significantly correlated with gastric cancer progression, and is an easily measured imaging biomarker reflecting patient survival.

Assessment of Micafungin Dosage Regimens in Patients with Cancer Using Pharmacokinetic/Pharmacodynamic Modeling and Monte Carlo Simulation

“…Strikingly, the micafungin CL in both groups was significantly lower than that reported in other populations (0.84 L/h) [ 22 , 23 , 24 , 25 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. Among the investigated covariates, body weight significantly influenced the micafungin CL in both groups, a finding that is in line with other pharmacokinetic studies, suggesting that obese patients may need higher doses of micafungin [ 40 , 41 ]. ALT and AST were the other parameters with a significant influence on CL, an expected finding given that micafungin is primarily eliminated via hepatic metabolism [ 20 ].…”

“…Overall, there were no differences in the pharmacokinetic parameters except for the estimated micafungin CL between the two groups. The significantly higher estimated CL found in patients with cancer, compared to those without cancer, might be attributable to increased hepatic blood flow due to the modulation of vascular activity of liver tissue [ 40 , 41 ]. Other possible reasons for such differences include the increased free fraction of micafungin due to changes in plasma proteins levels or other, yet unknown, reasons in patients with cancer, which warrant further investigation [ 40 , 41 ].…”

“…The significantly higher estimated CL found in patients with cancer, compared to those without cancer, might be attributable to increased hepatic blood flow due to the modulation of vascular activity of liver tissue [ 40 , 41 ]. Other possible reasons for such differences include the increased free fraction of micafungin due to changes in plasma proteins levels or other, yet unknown, reasons in patients with cancer, which warrant further investigation [ 40 , 41 ]. Strikingly, the micafungin CL in both groups was significantly lower than that reported in other populations (0.84 L/h) [ 22 , 23 , 24 , 25 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ].…”