Close Association between High Serum ALT and More Rapid Recurrence of Hepatocellular Carcinoma in Hepatectomized Patients with HCV-Associated Liver Cirrhosis and Hepatocellular Carcinoma

Abstract

We investigated whether or not a high serum alanine aminotransferase (ALT) level is associated with a more rapid recurrence of hepatocellular carcinoma (HCC) in hepatectomized patients with hepatitis C virus (HCV)-associated liver cirrhosis (LC) (HCV-LC) and HCC. Thirty-three hepatectomized patients with HCV-LC and HCC of a single nodule who had no histologic evidence of portal or hepatic vein invasion and who had been followed up for more than 3 years were included in the study. They were subdivided into two groups according to their serum ALT levels, ALT being a well-known marker of inflammatory necrosis in the liver. Seventeen patients whose serum ALT levels showed several peaks or plateaus above 80 international units (IU) were designated as the high ALT group, and 16 patients whose serum ALT levels showed a sustained low level below 80 IU until the first recurrence were designated as the low ALT group, and the interval between hepatectomy and the first recurrence was observed. In the high ALT group, HCC recurred within 3 years in 70.6% of the patients. In contrast, it recurred in only 18.8% of the low ALT group within the same period (p < 0.05). There was a significant difference (p = 0.0201) between the two groups in the cumulative nonrecurrence rate. The mean interval in recurrent patients between hepatectomy and the first recurrence in the high ALT group (23.6 ± 2.8 months; mean ± SE) was significantly (p < 0.02) shorter than that in the low ALT group (49.3 ± 9.7 months). The expected interval between hepatectomy and recurrence was as short as 2.8 ± 0.5 years (mean ± SE) in the high ALT group, compared with 5.8 ± 0.7 years in the low ALT group (p < 0.05). These results showed that the recurrence of HCC was accelerated in the high ALT group, suggesting that suppression of the rise in ALT level after hepatectomy by treatment with anti-inflammatory drugs may prolong the interval until recurrence by about 2 years in hepatectomized patients with HCC and HCV-LC.

Chemopreventive and anti-cancer properties of the aqueous extract of flowers of Butea monosperma

“…4). Reportedly, anti-inflammatory drugs that are known to regulate ALT levels can prolong the recurrence intervals of disease in HCC patients (Tarao et al, 2000). Further, normalization of serum VEGF levels in the AEBM-treated mice (Table 1) also corroborated its potential as an anti-cancer agent (Finn and Zhu, 2009;Kaseb et al, 2009).…”

Survival comparison between surgical resection and radiofrequency ablation for patients in BCLC very early/early stage hepatocellular carcinoma

“…Repeated necro-inflammation, regeneration and worsened fibrosis might promote HCC development in patients with chronic hepatitis C after SR [28]. Hepatic damage might favor HCC recurrence or occult intrahepatic metastases might grow in response to different growth factors in the background of the inflamed liver after treatment [30,31]. Antiviral therapy to normalize ALT level might be useful in preventing HCC recurrence after curative treatments [32,33].…”

Early immune-mediated response to ribavirin combined with IFN in patients with chronic hepatitis C

“…The reason for differences in periods after start of combination therapy may be due to the following: (1) Ribavirin can mediate immunomodulatory effects at a low concentration in serum [28]. (2) In the present study, CD4-positive T cell response was not necessarily HCV-specific, because we examined nonspecific cytokine production by CD4-positive T cells in response to PMA and ionomycin stimulation.…”

“…Hepatitis C virus (HCV) infection is associated with insidious and progressive liver disease that may eventually lead to cirrhosis or hepatocellular carcinoma [1,2]. Therefore, there is a great need to eliminate persistent HCV infection.…”