Tangtrongchitr Panicha, Poomsawat Sopee, Chongsrisawat Voranush, Honsawek Sittisak, Poovorawan Yong, Chongpison Yuda, Vejchapipat Paisarn
Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
Pediatr Surg Int. 2020 May;36(5):597-602. doi: 10.1007/s00383-020-04643-x. Epub 2020 Mar 21.
The prognosis of biliary atresia (BA) remains difficult to predict. This study evaluated the roles of hepatocyte growth factor (HGF) and its receptor (C-met) towards clinical outcome and native liver survival.
Hepatic HGF and C-met expression were determined using immunohistochemistry from liver biopsies of 41 BA patients during Kasai operation, and 17 non-cholestatic patients. The HGF and C-met expression was visually scored as per its intensity and percentage of stained area. BA patients were classified as high- and low-HGF and C-met receptor status. Native liver survival was compared between the two groups at 3-year follow-up. Data are shown as median and range.
Median age of BA patients was 2 (1-6) months. Hepatic HGF and C-met staining scores of BA patients were higher than those of non-cholestatic patients (P < 0.0001). There was a correlation between HGF and C-met staining scores (spearman r = 0.77, P < 0.0001). However, there was no association between their expression and early outcome at 6 months post-op. Mean follow-up time was 68.6 months. Survival analysis revealed that native liver survival at 1 year and 3 years were 88% and 77%, respectively. Additionally, 82.6% (19/23) of patients in the low-HGF group survived with native liver, compared with 66.7% (10/15) of those in high-HGF group (P = 0.436). For C-met expression, 78.6% (22/28) of low-score and 70% (7/10) of high score groups survived with native liver (P = 0.673).
Strong expression of hepatic HGF and its receptor in BA patients was demonstrated. However, the expression was not associated with the early outcome and native liver survival. These results suggest that HGF involved in the liver pathology of BA but its expression cannot be used as a prognostic indicator. Small sample size of patients was a main limitation. Further studies are warranted to validate our findings.
胆道闭锁（BA）的预后仍然难以预测。本研究评估了肝细胞生长因子（HGF）及其受体（C-甲硫氨酸）对临床结局和自体肝存活的作用。
采用免疫组织化学法，对41例接受葛西手术的BA患者及17例非胆汁淤积患者的肝活检组织进行肝HGF和C-甲硫氨酸表达的检测。根据HGF和C-甲硫氨酸的染色强度和染色面积百分比对其表达进行视觉评分。将BA患者分为HGF和C-甲硫氨酸受体高表达组和低表达组。在3年随访期内比较两组的自体肝存活率。数据以中位数和范围表示。
BA患者的中位年龄为2（1 - 6）个月。BA患者的肝HGF和C-甲硫氨酸染色评分高于非胆汁淤积患者（P < 0.0001）。HGF和C-甲硫氨酸染色评分之间存在相关性（斯皮尔曼r = 0.77，P < 0.0001）。然而，它们的表达与术后6个月的早期结局无关。平均随访时间为68.6个月。生存分析显示，1年和3年的自体肝存活率分别为88%和77%。此外，低HGF组82.6%（19/23）的患者自体肝存活，而高HGF组为66.7%（10/15）（P = 0.436）。对于C-甲硫氨酸表达，低评分组78.6%（22/28）和高评分组70%（7/10）的患者自体肝存活（P = 0.673）。
BA患者肝HGF及其受体表达较强。然而，该表达与早期结局和自体肝存活无关。这些结果表明，HGF参与了BA的肝脏病理过程，但其表达不能用作预后指标。患者样本量小是主要局限性。有必要进一步研究以验证我们的发现。
