Department of Gastroenterology, Faculty of Medicine, Çukurova University, Adana, Turkey.
J Gastrointest Cancer. 2022 Dec;53(4):1028-1033. doi: 10.1007/s12029-021-00738-3. Epub 2021 Nov 17.
Hepatocellular carcinoma (HCC) is the sixth among the most common cancers and the fourth among cancer-related causes of death in the world. In the evaluation of liver function in HCC patients, parameters such as albumin-bilirubin, prothrombin time-international normalized ratio (PT-INR) to albumin ratio (PTAR) are used among new methods other than Child-Pugh and MELD scores. Biomarkers are widely used in clinical practice in cases such as diagnosing various diseases, evaluating treatment response and predicting prognosis. We aimed to evaluate the prognostic role of serum ferritin and INR/albumin ratio in patients with chronic liver disease who develop HCC.
This retrospective study included 534 patients who were followed up with the diagnosis of HCC between 2009 and 2020. The patients with HCC etiology were evaluated in 3 groups (chronic hepatitis B group, chronic hepatitis C group, and other group). When comparing serum ferritin level and prothromin time-international normalized ratio to albumin ratio with Child Pugh score (CTP) in chronic liver patients with HCC, liver functional reserve and its role in predicting prognosis were investigated.
The serum ferritin level was 226 ± 334 in the CTP A group, 239 ± 302 in the CTP B group, and 678 ± 966 in the CTP C group, and the p value was 0.001. The PTAR CTP group was 0.35 ± 0.10, the CTP B group was 0.50 ± 0.26, the CTP C group was 1.18 ± 6.01, and the p value was 0.001. Multivariant analysis results showed that ferritin hazard ratio is 1.00, 95% CI 0.99-1.00, and p value was 0.09, and PTAR hazard ratio is 1.38, 95% CI 2.37-8.00, and p value was 0.49. The etiological distribution of HCC was determined as HBV (61.6%), HCV (19.9%), and other etiologies (18.5%). Significant values were determined for age, gender, glucose, GGT, T. cholesterol, and tumor diameter parameters according to etiological distribution.
Serum ferritin level and PTAR score increased in proportion to the severity of liver disease and were associated with poor prognosis. We think that high serum ferritin and PTAR score is a prognostic biomarker in predicting the synthesis function of the liver and mortality in critically ill patients with cirrhosis.
肝癌（HCC）是全球第六大常见癌症和第四大癌症相关死亡原因。在 HCC 患者肝功能评估中，除了 Child-Pugh 和 MELD 评分外，还使用了白蛋白-胆红素、凝血酶原时间-国际标准化比值（PT-INR）与白蛋白比值（PTAR）等新方法。生物标志物在诊断各种疾病、评估治疗反应和预测预后等方面在临床实践中得到广泛应用。本研究旨在评估血清铁蛋白和 INR/白蛋白比值在发生 HCC 的慢性肝病患者中的预后作用。
本回顾性研究纳入了 2009 年至 2020 年间诊断为 HCC 的 534 例患者。将 HCC 病因患者分为 3 组（慢性乙型肝炎组、慢性丙型肝炎组和其他组）。在比较慢性肝病伴 HCC 患者的血清铁蛋白水平和凝血酶原时间-国际标准化比值与白蛋白比值与 Child-Pugh 评分（CTP）时，研究了肝储备功能及其对预后的预测作用。
CTP A 组血清铁蛋白水平为 226±334，CTP B 组为 239±302，CTP C 组为 678±966，p 值为 0.001。PTAR CTP 组为 0.35±0.10，CTP B 组为 0.50±0.26，CTP C 组为 1.18±6.01，p 值为 0.001。多变量分析结果显示，铁蛋白风险比为 1.00，95%CI 为 0.99-1.00，p 值为 0.09，PTAR 风险比为 1.38，95%CI 为 2.37-8.00，p 值为 0.49。HCC 的病因分布为 HBV（61.6%）、HCV（19.9%）和其他病因（18.5%）。根据病因分布，年龄、性别、血糖、GGT、总胆固醇和肿瘤直径等参数具有显著意义。
血清铁蛋白水平和 PTAR 评分随肝病严重程度而增加，并与不良预后相关。我们认为，高血清铁蛋白和 PTAR 评分是预测肝硬化危重症患者肝脏合成功能和死亡率的预后生物标志物。
