An HCC Aggressiveness Index and Blood GTP, Bilirubin and Platelet Levels

Abstract

Four HCC characteristics typically inform tumor behavior: maximum tumor size, number of nodules, portal vein thrombosis and serum AFP level. The sum of these parameters was recently published as an HCC Aggressiveness Index. We aimed to validate this index retrospectively in a larger and independent HCC cohort of 2706 Italian HCC patients, and to evaluate a possible relationship between the index and liver function parameters. The scores in the HCC Aggressiveness Index were again found to significantly relate to patient survival. Furthermore, in a multiple logistic regression model of the Aggressiveness Index score categories, there were significant differences in several liver parameter terciles amongst the score categories, suggesting a relationship of liver function to tumor aggressiveness. It was concluded that a prognostically significant Tumor Aggressiveness Index was validated and was found to be related to levels of some common liver function parameters.

Serum Albumin Levels in Relation to Tumor Parameters in Hepatocellular Carcinoma Patients

“…Additionally, albumin, as part of the ALBI grading system, has been shown to be a quantitative, useful and prognostic indicator of liver dysfunction in HCC patients (21)(22)(23)(24)(25). Albumin has previously been reported to have direct HCC growth inhibitory properties in vitro (26,27), and there is also suggestive clinical evidence for an inhibitory effect on HCC in patients (30)(31)(32). Several studies have also shown a decrease in albumin levels in human HCC cells compared with the non-HCC liver (33)(34)(35).…”

“…II) renders this explanation less likely. However, there is recent evidence suggesting an association between HCC growth and poorer liver function, except for albumin, which seems to be protective (27,(30)(31)(32). The mechanisms by which albumin might protect against HCC growth or damage are not yet clear, although there is some experimental evidence that albumin might directly suppress HCC growth (26,27), leading us to consider the possibility that in addition to its reflection of liver synthetic function and systemic inflammation, it might also have a direct tumor growth-modulating function in HCC patients.…”

A Liver Index and its Relationship to Indices of HCC Aggressiveness

“…This large HCC cohort has been extensively characterized [1,2,10]. The Liver Index is comprised of the sum of the scores for these 4 parameters (Table 1) and relates to patient survival, as shown in the Kaplan-Meier and Cox analysis (Figure 1 and Table 2).…”

Plasma cholesterol and lipoprotein levels in relation to tumor aggressiveness and survival in HCC patients

“…Thus, each of the four tumor parameters was associated with a different pattern of lipids. The combination of all four tumor aggressiveness parameters together (the Tumor Aggressiveness Index 25,26 ) was only significantly associated with HDL cholesterol levels ( Table 1).…”