Department of Medicine, Cook County Health and Hospital System, 1900 West Polk Street, 15th Floor, Chicago, IL, 60612, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, Cook County Health and Hospital System, County, Chicago, IL, USA.
J Gastrointest Cancer. 2021 Mar;52(1):201-206. doi: 10.1007/s12029-020-00373-4.
Hepatocellular carcinoma (HCC) has tripled in incidence over the past 20 years and now ranks as the third leading cause of mortality attributed to cancer. Underlying pathophysiology is sustained hepatic inflammation which results in hepatocellular dysplasia and thus an environment prone to HCC. Considering the essential role of inflammation in the pathogenesis of HCC, we evaluated the prognostic utility of ferritin-transferrin ratio (FTR) in HCC.
We retrospectively reviewed the electronic medical records of patients with HCC (diagnosed on radiographic criteria and/or biopsy) from 2000 through 2015. We collected data regarding the patient demographics, laboratory investigations at the time of HCC diagnosis and prior to the initiation of treatment. Overall survival was calculated from the time of diagnosis, cases were censored at the date of last follow-up, if date of death was not known. Kaplan-Meier curves were estimated to evaluate the prognostic significance of FTR. Receiver operating characteristics (ROC) curve was plotted for FTR to predict mortality and identify cut-off value by optimized Youden's index.
Among the 176 patients identified by initial screening, 116 patients were eventually included for analysis. Overall median survival was 11.9 months. FTR, of note, was significantly lower in alive (6.9, p < 0.001). In univariate analysis, alfa-fetoprotein (AFP), aspartate aminotransferase (AST), serum ferritin (SF), transferrin (TFS), and FTR were significantly associated with mortality. On multivariate analysis for mortality, FTR, AFP, and epidemiologic factors predictive of mortality including male gender and advanced HCC were significant.
The ferritin-transferrin ratio (FTR), calculated at the time of HCC diagnosis could predict mortality in our cohort of patients. With an optimal cut-off of 7.7 for FTR were stratified into high- and low-risk groups. The hazard ratio between the two groups was 2.36 (p < 0.003). Future studies with longitudinal follow-up of FTR at intervals and important time points (e.g., perioperative) might provide more insights to its prognostic value.
在过去的 20 年中，肝细胞癌 (HCC) 的发病率增加了两倍，现在是癌症死亡的第三大主要原因。其潜在的病理生理学是持续的肝脏炎症，导致肝细胞发育不良，从而导致 HCC 易于发生。鉴于炎症在 HCC 发病机制中的重要作用，我们评估了铁蛋白-转铁蛋白比值 (FTR) 在 HCC 中的预后效用。
我们回顾性分析了 2000 年至 2015 年期间通过影像学标准和/或活检诊断为 HCC 的患者的电子病历。我们收集了有关患者人口统计学、HCC 诊断时和治疗前的实验室检查数据。从诊断时开始计算总生存期，对于不知道死亡日期的病例，截止日期为最后一次随访日期。通过 Kaplan-Meier 曲线评估 FTR 的预后意义。绘制 ROC 曲线，通过优化 Youden 指数预测死亡率并确定截断值。
通过初步筛选确定的 176 例患者中，最终有 116 例纳入分析。总体中位生存期为 11.9 个月。值得注意的是，存活患者的 FTR 明显较低 (6.9，p < 0.001)。在单因素分析中，甲胎蛋白 (AFP)、天冬氨酸转氨酶 (AST)、血清铁蛋白 (SF)、转铁蛋白 (TFS) 和 FTR 与死亡率显著相关。多因素分析表明，FTR、AFP 和包括男性和晚期 HCC 在内的预测死亡率的流行病学因素与死亡率显著相关。
在 HCC 诊断时计算的铁蛋白-转铁蛋白比值 (FTR) 可预测我们患者队列的死亡率。FTR 的最佳截断值为 7.7，可以将患者分为高风险和低风险组。两组之间的危险比为 2.36(p < 0.003)。未来的研究需要对 FTR 进行纵向随访，并在重要的时间点 (例如围手术期) 进行检测，以提供更多关于其预后价值的见解。
