Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan.
J Formos Med Assoc. 2023 Oct;122(10):1008-1017. doi: 10.1016/j.jfma.2023.04.009. Epub 2023 May 3.
Surgical resection is a curative therapy for early-stage hepatocellular carcinoma (HCC); however, HCC recurrence is not uncommon. Identifying outcome predictors helps to manage the disease. Gamma-glutamyl transferase (GGT) may predict the development of HCC, but its role to predict the outcomes after surgical resection of HCC was unclear. This study aimed to investigate pre-operative GGT levels for outcome prediction in patients with hepatitis B virus (HBV)-related HCC.
We conducted a retrospective cohort study to include patients with HBV-related HCC receiving surgical resection. Clinical information, HCC characteristics and usage of antiviral therapy were collected. A time-dependent Cox proportional hazard regression analysis were used to predict HCC recurrence and survival.
A total of 699 consecutive patients with HBV-related HCC who received surgical resection with curative intent between 2004 and 2013 were included. After a median of 4.4 years, 266 (38%) patients had HCC recurrence. Pre-operative GGT positively correlated with cirrhosis, tumor burden and significantly increased in patients to develop HCC recurrence. Multivariable analysis demonstrated that pre-operative GGT ≥38 U/L increased 57% risk (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.20-2.06) of recurrent HCC after adjustment for confounding factors. Specifically, pre-operative GGT ≥38 U/L predicted early (<2 years) HCC recurrence (HR: 1.94, 95% CI: 1.30-2.89). Moreover, pre-operative GGT ≥38 U/L predicted all-cause mortality (HR: 1.73, 95% CI: 1.06-2.84) after surgery.
Pre-operative GGT levels ≥38 U/L independently predict high risks of HCC recurrence and all-cause mortality in HBV-related HCC patients receiving surgical resection.
手术切除是治疗早期肝细胞癌（HCC）的一种有治愈可能的疗法；然而，HCC 复发并不罕见。确定预后预测因子有助于对疾病进行管理。谷氨酰转肽酶（GGT）可能预测 HCC 的发生，但它在预测乙型肝炎病毒（HBV）相关 HCC 手术后的结局中的作用尚不清楚。本研究旨在探讨术前 GGT 水平对接受手术切除的 HBV 相关 HCC 患者结局的预测价值。
我们进行了一项回顾性队列研究，纳入了接受手术切除的 HBV 相关 HCC 患者。收集了临床信息、HCC 特征和抗病毒治疗的使用情况。采用时间依赖性 Cox 比例风险回归分析预测 HCC 复发和生存。
共纳入了 2004 年至 2013 年间接受根治性手术切除的 699 例连续 HBV 相关 HCC 患者。中位随访时间为 4.4 年后，266 例（38%）患者发生 HCC 复发。术前 GGT 与肝硬化、肿瘤负荷呈正相关，且在发生 HCC 复发的患者中显著升高。多变量分析显示，在调整混杂因素后，术前 GGT≥38 U/L 使 HCC 复发的风险增加 57%（风险比 [HR]：1.57，95%置信区间 [CI]：1.20-2.06）。具体而言，术前 GGT≥38 U/L 预测了早期（<2 年）HCC 复发（HR：1.94，95% CI：1.30-2.89）。此外，术前 GGT≥38 U/L 预测了手术后的全因死亡率（HR：1.73，95% CI：1.06-2.84）。
术前 GGT 水平≥38 U/L 独立预测了接受手术切除的 HBV 相关 HCC 患者 HCC 复发和全因死亡率的高风险。
