Department of Surgery I, Sapporo Medical University Hospital, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, 060-8543, Japan.
J Gastrointest Surg. 2011 Aug;15(8):1433-9. doi: 10.1007/s11605-011-1566-y. Epub 2011 May 24.
The branched-chain amino acid/tyrosine ratio (BTR) reflects the amino acid balance and the severity of liver disease. The aim of the present study was to determine the relationship between BTR and liver function in patients with hepatocellular carcinoma (HCC). Furthermore, we evaluated the clinical usefulness of BTR as a prognostic indicator of disease-free and overall patient survival after initial hepatectomy.
Between January 2004 and December 2008, 105 consecutive HCC patients who underwent initial hepatectomy were enrolled in this study. The correlation between BTR and preoperative liver functional indicators was evaluated. The cutoff levels of BTR for 2-year survival prediction were evaluated using a dot blot diagram. The patients were divided into high BTR (4.5 or higher) and low BTR (4.4 or lower) groups and these were compared in terms of clinical variables such as liver functional indicators, operative variables, and tumor characteristics.
The preoperative BTR level decreased according to the severity of liver disease. BTR was correlated with the albumin, bilirubin, and prealbumin levels, as well as the prothrombin time. Although the preoperative liver function was significantly different between the high BTR and low BTR groups, the operative variables and tumor-related variables were not found to be significantly different. Postoperative complications in the high BTR group were significantly less frequent than in the low BTR group (p = 0.003). Disease-free and overall patient survival in the high BTR group were significantly longer than in the low BTR group (p < 0.001 and p = 0.021, respectively).
BTR reflected the pathological liver background with a high correlation to the other liver functional indicators. BTR is thus considered to be a useful marker to predict postoperative complications, disease-free survival, and overall survival of HCC patients after initial hepatectomy. It is, therefore, a useful indicator of liver function and a predictor for the risk of cancer recurrence and overall survival in HCC patients.
支链氨基酸/酪氨酸比值（BTR）反映了氨基酸平衡和肝脏疾病的严重程度。本研究旨在确定 BTR 与肝细胞癌（HCC）患者肝功能之间的关系。此外，我们评估了 BTR 作为初始肝切除术后无病和总患者生存的预后指标的临床实用性。
本研究纳入了 2004 年 1 月至 2008 年 12 月期间接受初始肝切除术的 105 例连续 HCC 患者。评估了 BTR 与术前肝功能指标之间的相关性。使用点图评估 BTR 的截断值以预测 2 年生存率。根据 BTR 将患者分为高 BTR（4.5 或更高）和低 BTR（4.4 或更低）组，并比较两组患者的肝功能指标、手术变量和肿瘤特征等临床变量。
术前 BTR 水平随着肝脏疾病的严重程度而降低。BTR 与白蛋白、胆红素和前白蛋白水平以及凝血酶原时间相关。尽管高 BTR 和低 BTR 组之间的术前肝功能存在显著差异，但手术变量和肿瘤相关变量并无显著差异。高 BTR 组的术后并发症发生率明显低于低 BTR 组（p=0.003）。高 BTR 组的无病生存和总生存明显长于低 BTR 组（p<0.001 和 p=0.021）。
BTR 反映了具有高相关性的其他肝功能指标的病理肝脏背景。因此，BTR 被认为是预测 HCC 患者初始肝切除术后术后并发症、无病生存和总生存的有用标志物。它是肝功能的有用指标，也是 HCC 患者癌症复发和总生存风险的预测指标。
