Akuta Norio, Kawamura Yusuke, Fujiyama Shunichiro, Sezaki Hitomi, Hosaka Tetsuya, Saitoh Satoshi, Kobayashi Mariko, Arase Yasuji, Ikeda Kenji, Suzuki Yoshiyuki, Kumada Hiromitsu, Suzuki Fumitaka
Department of Hepatology, Toranomon Hospital and Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
Liver Research Laboratory, Toranomon Hospital, Tokyo, Japan.
Oncology. 2023;101(11):738-752. doi: 10.1159/000533303. Epub 2023 Aug 31.
Personalized medicine and molecular therapies with the diagnosis of somatic genetic alterations are expected to be developed for liver cancer. Nevertheless, it is unknown whether a mutation in the telomere reverse transcriptase promoter (TERT C228T) in serum cfDNA might be useful for making prognostic predictions after surgical resection for primary liver cancer.
This cohort study retrospectively investigated 111 patients who had undergone surgical resection of liver cancer for the first time. We investigated the differences between clinicopathological features and prognosis according to classification of three tumor markers, including AFP, PIVKAII, and TERT C228T.
Multivariate analysis identified etiology (fatty liver disease vs. HBV odds ratio [OR] 6.853) and fibrosis stage (2-4, OR: 0.137) as determinants of TERT C228T-positive liver cancer with normal levels of AFP and PIVKAII (TERT single positive liver cancer). TERT single positive (Yes, OR: 0.301), fibrosis (FIB)-4 index (≥3.25, OR: 2.038), Child-Pugh classification (B, OR: 4.975), and number of tumors (≥2, OR: 4.098) were identified as determinants of the recurrence of liver cancer. TERT single positive (Yes, OR: 3.311), FIB-4 index (≥3.25, OR: 0.433), and number of tumors (≥2, OR: 0.262) were identified as determinants of disease-free survival.
Our results highlight the impact of classification of prognostic tumor markers. TERT single positive is one predictor of favorable prognosis after surgical resection for liver cancer.
预计将针对肝癌开发基于体细胞基因改变诊断的个性化医疗和分子疗法。然而，血清游离DNA中端粒逆转录酶启动子（TERT C228T）的突变是否有助于对原发性肝癌手术切除后的预后进行预测尚不清楚。
这项队列研究回顾性调查了111例首次接受肝癌手术切除的患者。我们根据三种肿瘤标志物（包括甲胎蛋白、异常凝血酶原和TERT C228T）的分类，研究了临床病理特征和预后之间的差异。
多变量分析确定病因（脂肪肝疾病与乙肝病毒感染，优势比[OR]6.853）和纤维化阶段（2-4期，OR：0.137）是甲胎蛋白和异常凝血酶原水平正常的TERT C228T阳性肝癌（TERT单阳性肝癌）的决定因素。TERT单阳性（是，OR：0.301）、纤维化（FIB）-4指数（≥3.25，OR：2.038）、Child-Pugh分级（B级，OR：4.975）和肿瘤数量（≥2个，OR：4.098）被确定为肝癌复发的决定因素。TERT单阳性（是，OR：3.311）、FIB-4指数（≥3.25，OR：0.433）和肿瘤数量（≥2个，OR：0.262）被确定为无病生存期的决定因素。
我们的结果突出了预后肿瘤标志物分类的影响。TERT单阳性是肝癌手术切除后预后良好的一个预测指标。
