Pereyra David, Offensperger Florian, Klinglmueller Florian, Haegele Stefanie, Oehlberger Lukas, Gruenberger Thomas, Brostjan Christine, Starlinger Patrick
Department of Surgery, Medical University of Vienna, General Hospital, Vienna, Austria.
Core Unit for Medical Statistics and Informatics, Medical University of Vienna, Vienna, Austria.
PLoS One. 2017 Apr 13;12(4):e0175359. doi: 10.1371/journal.pone.0175359. eCollection 2017.
Antithrombin III (ATIII) has been reported to be associated with liver pathologies and was shown to predict outcome in patients undergoing liver resection for hepatocellular carcinoma. We now aimed to assess whether perioperative ATIII-activity could predict postoperative outcome in patients without underlying liver disease, as well as in a routine clinical setting of patients undergoing hepatic resection.
ATIII-activity was evaluated preoperatively and on the first (POD1) and fifth day after liver resection in a retrospective evaluation cohort of 228 colorectal cancer patients with liver metastasis (mCRC). We further aimed to prospectively validate our results in a set of 177 consecutive patients undergoing hepatic resection.
Patients developing postoperative liver dysfunction (LD) had a more pronounced postoperative decrease in ATIII-activity (P<0.001). ATIII-activity on POD1 significantly predicted postoperative LD (P<0.001, AUC = 84.4%) and remained independent upon multivariable analysis. A cut-off value of 61.5% ATIII-activity was determined using ROC analysis. This cut-off was vital to identify high-risk patients for postoperative LD, morbidity, severe morbidity and mortality (P<0.001, respectively) with a highly accurate negative predictive value of 97%, which could be confirmed for LD (P<0.001) and mortality (P = 0.014) in our independent validation cohort. Further, mCRC patients below our cut-off suffered from a significantly decreased overall survival (OS) at 1 and 3 years after surgery (P = 0.011, P = 0.025).
The routine laboratory parameter ATIII-activity on POD1 independently predicted postoperative LD and was associated with clinical outcome. Patients with a postoperative ATIII-activity <61.5% might benefit from close monitoring and timely initiation of supportive therapy.
ClinicalTrials.gov NCT01700231.
已有报道称抗凝血酶III（ATIII）与肝脏病变有关，且其可预测肝细胞癌肝切除患者的预后。我们现在旨在评估围手术期ATIII活性是否能够预测无潜在肝脏疾病患者以及肝切除患者常规临床情况下的术后预后。
在一项对228例伴有肝转移的结直肠癌患者（mCRC）的回顾性评估队列中，于术前、肝切除术后第一天（POD1）和第五天评估ATIII活性。我们进一步旨在对一组177例连续接受肝切除的患者进行前瞻性验证我们的结果。
发生术后肝功能障碍（LD）的患者术后ATIII活性下降更为明显（P<0.001）。POD1时的ATIII活性显著预测术后LD（P<0.001，AUC = 84.4%），且在多变量分析中保持独立。使用ROC分析确定ATIII活性的临界值为61.5%。该临界值对于识别术后LD、发病率、严重发病率和死亡率的高危患者至关重要（分别为P<0.001），其具有97%的高度准确的阴性预测值，这在我们的独立验证队列中对于LD（P<0.001）和死亡率（P = 0.014）可得到证实。此外，低于我们临界值的mCRC患者术后1年和3年的总生存期（OS）显著降低（P = 0.011，P = 0.025）。
POD1时的常规实验室参数ATIII活性独立预测术后LD，并与临床结局相关。术后ATIII活性<61.5%的患者可能受益于密切监测和及时启动支持治疗。
ClinicalTrials.gov NCT01700231。
