Liver Unit, Department of Gastroenterology and Hepatology, Tel-Aviv Medical Center, Tel-Aviv 62431, Israel.
Izmir Biomedicine and Genome Center, Dokuz Eylul University, Izmir 35340, Turkey.
World J Gastroenterol. 2018 Apr 21;24(15):1641-1649. doi: 10.3748/wjg.v24.i15.1641.
To investigate novel predictors of survival in hepatocellular carcinoma (HCC) patients following transarterial chemoembolization (TACE).
One hundred sixty seven patients with un-resectable HCC were retrospectively analyzed to identify factors that might contribute to their HCC biology and aggressiveness. We correlated routine laboratory results (total bilirubin, AST, ALKP, GGTP, albumin .) to maximum tumor diameter, number of tumor nodules, portal vein thrombosis and blood alpha-fetoprotein levels. These 4 parameters were previously combined to form an aggressiveness index (AgI). We used The Wilcoxon rank-sum (Mann-Whitney), to test the correlation between the AgI categories and liver function parameters. The Cox proportional hazards model was applied to evaluate the categories of AgI associated with overall survival.
The AgI was strongly correlated with survival in this novel patient population. Three year survival probability for AgI > or < 4 was 42.4% 61.8%; < 0.0863 respectively. Several factors independently correlated with AgI using univariate multiple logistic regression of AgI with 8 laboratory parameters. Lower albumin levels had an OR of 2.56 (95%CI: 1.120-5.863 < 0.026), elevated Alkaline phosphatase and gamma glutamyl transpeptidase (GGTP) had ORs of 1.01 (95%CI: 1.003-1.026, < 0.017) and 0.99 (95%CI: 0.99-1.00, < 0.053) respectively. In a Cox proportional hazard model combining mortality for AgI score and liver function parameters, only GGTP levels and the AgI were independently associated with survival. An AgI > 4 had HR for mortality of 2.18 (95%CI: 1.108-4.310, < 0.024). GGTP's single unit change had a HR for mortality of 1.003 (95%CI: 1.001-1.006, < 0.016). These were considered in the final multivariate model with the total cohort. An AgI > 4 had a HR for mortality of 2.26 (95%CI: 1.184-4.327, < 0.016). GGTP had a HR of 1.003 (95%CI: 1.001-1.004, < 0.001).
Our study validates the AgI in a new population with un-resectable HCC patients undergoing TACE. The analysis establishes a correlation between GGTP and the AgI.
探讨经肝动脉化疗栓塞（TACE）后肝癌（HCC）患者的生存新预测因子。
回顾性分析 167 例不可切除 HCC 患者的资料，以确定可能影响其 HCC 生物学和侵袭性的因素。我们将常规实验室结果（总胆红素、AST、ALKP、GGTP、白蛋白等）与最大肿瘤直径、肿瘤结节数量、门静脉血栓形成和血液甲胎蛋白水平相关联。这 4 个参数以前被组合成一个侵袭性指数（AgI）。我们使用 Wilcoxon 秩和检验（Mann-Whitney）来检验 AgI 类别与肝功能参数之间的相关性。应用 Cox 比例风险模型评估与总生存期相关的 AgI 类别。
AgI 与该新型患者人群的生存有很强的相关性。AgI>4 与 AgI<4 的 3 年生存率分别为 42.4%和 61.8%；<0.0863。使用包含 8 个实验室参数的 AgI 的单变量多因素逻辑回归对 AgI 进行分析，发现多个因素与 AgI 独立相关。较低的白蛋白水平的比值比（OR）为 2.56（95%CI：1.120-5.863；<0.026），碱性磷酸酶和γ-谷氨酰转肽酶（GGTP）的 OR 分别为 1.01（95%CI：1.003-1.026；<0.017）和 0.99（95%CI：0.99-1.00；<0.053）。在将 AgI 评分和肝功能参数的死亡率进行 Cox 比例风险模型联合分析中，只有 GGTP 水平和 AgI 与生存独立相关。AgI>4 的死亡率 HR 为 2.18（95%CI：1.108-4.310；<0.024）。GGTP 单一单位的变化 HR 为 1.003（95%CI：1.001-1.006；<0.016）。这些因素在包含总队列的最终多变量模型中进行了考虑。AgI>4 的死亡率 HR 为 2.26（95%CI：1.184-4.327；<0.016）。GGTP 的 HR 为 1.003（95%CI：1.001-1.004；<0.001）。
我们的研究在接受 TACE 的不可切除 HCC 患者的新人群中验证了 AgI 的有效性。该分析建立了 GGTP 与 AgI 之间的相关性。
