# Assessment of non-tumor liver parenchyma damage in advanced gastric cancer treatment with transarterial infusion chemotherapy: a study using imaging and hepatic injury indicators

## TL;DR

This study shows that transarterial infusion chemotherapy for advanced gastric cancer can cause early liver damage, detectable through imaging and blood tests before traditional methods.

## Contribution

The study introduces a sensitive method combining CT imaging and biomarkers to detect early liver injury from chemotherapy.

## Key findings

- TAI chemotherapy caused reduced liver-to-spleen attenuation ratio and increased spleen volume, indicating hepatic steatosis and splenomegaly.
- Liver fibrosis indices (APRI and FIB-4) increased significantly, suggesting progression of hepatic fibrosis.
- Traditional liver function scores (ALBI and Child-Pugh) showed no significant changes, highlighting the sensitivity of the new method.

## Abstract

This study aimed to evaluate non-tumor liver parenchymal injury in advanced gastric cancer patients undergoing transarterial infusion chemotherapy (TAI) using imaging parameters and liver injury biomarkers, providing objective evidence for early detection of drug-induced liver injury.

A retrospective analysis was conducted on 52 advanced gastric cancer patients who received TAI at our center from July 2015 to July 2023. Abdominal CT images and laboratory data were collected before and after treatment. Imaging postprocessing software was used to measure the liver-to-spleen (L/S) attenuation ratio and spleen volume. Liver fibrosis indices (APRI, FIB-4) and liver function scores (Child-Pugh, ALBI) were calculated. Statistical analysis included Wilcoxon rank-sum test and paired t-test for pre- and post-treatment comparisons.

Patients received an average of 2.80 TAI cycles over 8.3 weeks. Post-treatment, 76.92% (40/52) showed a significant reduction in L/S attenuation ratio (1.23 ± 0.13 vs. 1.12 ± 0.1, P < 0.01), and 73.1% (38/52) exhibited increased spleen volume (151,219.33 mm³ vs. 202, 171.32 mm³, P < 0.01). Liver fibrosis indices significantly increased: APRI (0.19 ± 0.15 vs. 0.37 ± 0.27) and FIB-4 (1.29 ± 0.88 vs. 2.24 ± 1.38) (P < 0.01). No significant changes were observed in ALBI (-2.7 ± 0.41 vs. -2.58 ± 0.43) or Child-Pugh scores (5.31 ± 0.47 vs. 5.38 ± 0.64) (P > 0.05).

Transarterial infusion chemotherapy for advanced gastric cancer results in short-term damage to the non-tumor liver parenchyma, with imaging findings showing hepatic steatosis (reduction in L/S ratio) and splenomegaly. Serum markers suggest progression of hepatic fibrosis, consistent with the pathological features of hepatic sinusoidal obstruction syndrome. The combination of CT imaging and APRI/FIB-4 provides a sensitive method for detecting subclinical liver injury, reflecting pathological changes earlier than traditional liver function scores.