Nishikawa Hiroki, Osaki Yukio, Komekado Hideyuki, Sakamoto Azusa, Saito Sumio, Nishijima Norihiro, Nasu Akihiro, Arimoto Akira, Kita Ryuichi, Kimura Toru
Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Tennoji-ku, Osaka 543-0027, Japan.
Department of Surgery, Osaka Red Cross Hospital, Tennoji-ku, Osaka 543-0027, Japan.
Oncol Rep. 2015 Mar;33(3):1071-8. doi: 10.3892/or.2014.3691. Epub 2014 Dec 22.
We aimed to examine the relationship between the preoperative GSA index [uptake ratio of the liver to the liver plus heart at 15 min (LHL15) to uptake ratio of the heart at 15 min to that at 3 min (HH15) ratio] calculated from 99mTc‑labeled diethylene triamine pentaacetate-galactosyl human serum albumin (99mTc-GSA) scintigraphy and background liver fibrosis and to investigate whether the GSA index can be a useful predictor in hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) patients treated with surgical resection (SR). A total of 213 HCV-related HCC patients were analyzed. Receiver operating characteristic (ROC) curve analysis was performed for calculating the area under the ROC (AUROC) for nine noninvasive parameters including GSA index, indocyanine green retention at 15 min, aspartate aminotransferase (AST) to platelet ratio index, FIB-4 index, AST to alanine aminotransferase ratio, serum albumin, total bilirubin, platelet count and prothrombin time for cirrhosis. We also examined predictive factors associated with overall survival (OS) and recurrence-free survival (RFS) after SR in univariate and multivariate analyses. There were 153 males and 60 females with the mean age of 69.9 years. The median observation periods were 2.8 years. The mean maximum tumor size was 4.1 cm. HH15 ranged from 0.452 to 0.897. LHL15 ranged from 0.669 to 0.982. The mean value of the GSA index was 1.41. Among the nine parameters, the GSA index yielded the highest AUROC for cirrhosis with a level of 0.786 at an optimal cut-off value of 1.37 (sensitivity, 65.9%; specificity, 79.0%). In multivariate analyses, the GSA index was an independent predictor (P<0.001) linked to RFS and it had a marginal significance in terms of OS (P=0.074). In conclusion, the preoperative GSA index can be a useful predictor in HCV-related HCC patients treated with SR.
我们旨在研究通过99mTc标记的二乙三胺五乙酸 - 半乳糖基人血清白蛋白（99mTc - GSA）闪烁扫描术计算出的术前GSA指数[15分钟时肝脏与肝脏加心脏的摄取比（LHL15）与15分钟时心脏摄取比与3分钟时心脏摄取比的比值（HH15）之比]与背景肝纤维化之间的关系，并探讨GSA指数是否可作为接受手术切除（SR）治疗的丙型肝炎病毒（HCV）相关肝细胞癌（HCC）患者的有用预测指标。共分析了213例HCV相关HCC患者。对包括GSA指数、15分钟时吲哚菁绿滞留率、天冬氨酸转氨酶（AST）与血小板比值指数、FIB - 4指数、AST与丙氨酸转氨酶比值、血清白蛋白、总胆红素、血小板计数和肝硬化患者的凝血酶原时间在内的九个非侵入性参数进行了受试者操作特征（ROC）曲线分析，以计算ROC曲线下面积（AUROC）。我们还在单变量和多变量分析中检查了与SR后总生存期（OS）和无复发生存期（RFS）相关的预测因素。其中男性153例，女性60例，平均年龄69.9岁。中位观察期为2.8年。平均最大肿瘤大小为4.1 cm。HH15范围为0.452至0.897。LHL15范围为0.669至0.982。GSA指数的平均值为1.41。在这九个参数中，GSA指数对肝硬化的AUROC最高，在最佳临界值为1.37时水平为0.786（敏感性为65.9%；特异性为79.0%）。在多变量分析中, GSA指数是与RFS相关的独立预测指标（P<0.001），并且在OS方面具有边缘显著性（P = 0.074）。总之，术前GSA指数可作为接受SR治疗的HCV相关HCC患者的有用预测指标。
