Diagnostic value of the γ-glutamyltransferase and alanine transaminase ratio, alpha-fetoprotein, and protein induced by vitamin K absence or antagonist II in hepatitis B virus-related hepatocellular carcinoma

Guang-rong, Wang; Lu, Xiaolan; Du, Qin; Zhang, Guo-Yuan; Wang, Dongsheng; Wang, Qiang; Guo, Xiaolan

doi:10.1038/s41598-020-70241-5

“…ALT levels are often used to evaluate hepatocyte damage; ALT can be released from damaged hepatocytes into the blood. In acute and chronic viral hepatitis, alcoholic hepatitis, and cirrhosis, ALT levels are elevated to varying degrees; meanwhile, in patients with HCC, ALT levels tend to be within or below the normal range [25]. Based on these findings, we hypothesized that the GGT/ALT ratio may reflect the invasiveness of HCC.…”

Section: Discussionmentioning

confidence: 98%

LDH and GGT/ALT Ratio as Novel Prognostic Biomarkers in Hepatocellular Carcinoma Patients after Liver Transplantation

Zhang

¹

,

Jiao

²

2021

Computational and Mathematical Methods in Medicine

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Background. Liver inflammation indices reflect its inflammatory microenvironment, which may play a role in the proliferation, invasion, and migration of carcinoma. This study is aimed at exploring the prognostic significance of serum lactate dehydrogenase (LDH) levels and gamma-glutamyl transferase (GGT)/alanine aminotransferase (ALT) ratio in hepatocellular carcinoma after liver transplant (LT). Methods. We retrospectively analyzed data from 155 patients with a pathologically confirmed diagnosis of hepatocellular carcinoma who received LT between January 2013 and September 2017. We used receiver operating characteristics (ROC) curves to determine the optimal LDH and GGT/ALT ratio cut-off values. The Kaplan–Meier method and the logarithmic rank test were used to compare the survival curves without recurrence (RFS) and overall survival (OS). Univariate and multivariate analyses were used to identify factors associated with survival. Results. Serum LDH levels were significantly associated with the Child-Pugh score ( P = 0.037 ), largest tumor size (<50 vs. ≥50 mm) ( P = 0.017 ), tumor count (<3 vs. ≥3) ( P = 0.009 ), microvascular invasion ( P = 0.006 ), and the Milan criteria ( P ≤ 0.001 ). The serum GGT/ALT ratio was significantly correlated with alpha-fetoprotein (AFP) levels (of <400 vs. ≥400 ng/ml) ( P ≤ 0.001 ), largest tumor size (of <50 vs. ≥50 mm) ( P ≤ 0.001 ), the Edmondson grade (I-II vs. III-IV) ( P = 0.028 ), microvascular invasion ( P ≤ 0.001 ), and the Milan ( P = 0.002 ) and Hangzhou criteria ( P = 0.018 ). The survival curves showed that the patients with high LDH and the GGT/ALT ratio were associated with poor RFS and OS ( P < 0.05 ). Univariate and multivariate analyses showed that AFP levels of ≥400 ng/ml, largest tumor size of ≥50 mm, microvascular invasion, LDH levels of ≥213.5 U/l, and the GGT/ALT ratio of ≥3.1338 were factors independently associated with RFS. Conclusion. Elevated LDH levels and the GGT/ALT ratio before LT were associated with poor OS and RFS in the present study. These factors could be used in the prognostication of patients with hepatocellular carcinoma undergoing LT.

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“…The α-FP and PIVKA-II are widely used serum tumor markers, despite that facts that approximately 40% of patients with HCC have negative α-FP, the positive predictive value ofα-FP is about 9%–32%, and PIVKA-II levels are influenced by several factors other than HCC [ 21 22 23 24 25 ]. Previous studies have reported the correlations between serum α-FP and PIVKA-II levels and the size of HCC [ 21 22 23 24 25 ]. Similarly, the present study showed that serum α-FP and PIVKA-II levels in the large group were significantly higher than those in the small group.…”

Section: Discussionmentioning

confidence: 99%

“…Elevation of serum ALT levels can also be explained in a similar context. ALT is a protein that is expressed in various human tissues and organs, with the highest expression observed in the mitochondria of hepatocytes [ 23 ]. ALT can be used as a biomarker evaluating hepatocyte destruction.…”

Section: Discussionmentioning

confidence: 99%

Impact of tumor size on hepatectomy outcomes in hepatocellular carcinoma: a nationwide propensity score matching analysis

Hong

¹

,

Lee

²

,

Lee

³

et al. 2022

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Purpose The aim of this study was to compare surgical outcomes after liver resection for hepatocellular carcinoma (HCC) according to tumor size using a large, nationwide cancer registry-based cohort and propensity score matching. Methods From 2008 to 2015, a total of 12,139 patients were diagnosed with liver cancer and registered in the Korean Primary Liver Cancer Registry. Patients without distant metastasis who underwent hepatectomy as a primary treatment were selected. We performed 1:1 propensity score matching between the small (<5 cm), large (≥5 cm and <10 cm), and huge (≥10 cm) groups. Results Overall, 265 patients in the small and large groups were compared, and 64 patients each in the large and huge groups were compared. The overall and progression-free survival rates were significantly lower in the large group than in the small group (P < 0.001 and P < 0.001, respectively). Overall survival tended to be poorer in the huge group than in the large group (P = 0.051). The progression-free survival rate was significantly lower in the huge group than in the large group (P = 0.002). Conclusion Although primary liver resection can be considered even in patients with huge HCC, greater caution with careful screening for recurrence is needed.

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“…However, there existed conventional prognostic indicators that are poor at predicting the prognosis of HCC after hepatectomy [3]. Alpha-fetoprotein (AFP) has been used as an indicator of HCC diagnosis and prognosis, but only 60% of patients with HCC have positive AFP [4]. Previous studies have shown that AFP-positive was associated with worse biological behavior and inferior survival compared with AFP-negative patients [5].…”

Section: Introductionmentioning

confidence: 99%

Alpha-Fetoprotein Ratio Predicts Alpha-Fetoprotein Positive Hepatocellular Cancer Patient Prognosis after Hepatectomy

Sun

¹

,

Cen

²

,

Tang

³

et al. 2022

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Background. This study was conducted to investigate the effect of alpha-fetoprotein (AFP) ratio on the prognosis of AFP-positive hepatocellular carcinoma (HCC) patients after hepatectomy. Methods. We retrospectively included 879 HCC patients with AFP-positive who underwent hepatectomy from February 2012 to October 2017 and randomly divided into training cohort and validation cohort. AFP ratio was equal to the AFP level within one week before hepatectomy to AFP level within 20-40 days after surgery. The end point of follow-up was disease-free survival (DFS) and overall survival (OS). Results. AFP ratio was not associated with clinical characteristics in training cohort and validation cohort. According to the X-tile software, the optimum cut-off point was 17.8 for AFP ratio. Significant differences between AFP ratio high and AFP ratio low were observed in DFS and OS in both cohort ( p < 0.05 ). Kaplan-Meier curves and receiver-operating curves were showed that AFP ratio was better than AFP level preoperation in predicting the prognosis of AFP-positive HCC patients after hepatectomy. The multivariate analysis demonstrated that AFP ratio was a significant independent risk factor for both OS and DFS in HCC patients with AFP-positive. Conclusions. AFP ratio might be a prognosis predictor for HCC patients with AFP-positive after hepatectomy.

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Diagnostic value of the γ-glutamyltransferase and alanine transaminase ratio, alpha-fetoprotein, and protein induced by vitamin K absence or antagonist II in hepatitis B virus-related hepatocellular carcinoma

Cited by 16 publications

References 78 publications

LDH and GGT/ALT Ratio as Novel Prognostic Biomarkers in Hepatocellular Carcinoma Patients after Liver Transplantation

LDH and GGT/ALT Ratio as Novel Prognostic Biomarkers in Hepatocellular Carcinoma Patients after Liver Transplantation

Impact of tumor size on hepatectomy outcomes in hepatocellular carcinoma: a nationwide propensity score matching analysis

Alpha-Fetoprotein Ratio Predicts Alpha-Fetoprotein Positive Hepatocellular Cancer Patient Prognosis after Hepatectomy

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