Preoperative Aspartate Aminotransferase to Platelet Ratio is an Independent Prognostic Factor for Hepatitis B-Induced Hepatocellular Carcinoma After Hepatic Resection

Shen, Shunli; Fu, Shunjun; Chen, Bin; Kuang, Ming; Li, Shaoqiang; Hua, Yunpeng; Liu, Liang; Guo, Pi; Hao, Yuantao; Peng, Baogang

doi:10.1245/s10434-014-3771-x

Cited by 98 publications

(110 citation statements)

References 29 publications

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“…Serum markers and developed scores are of rising significance in noninvasive diagnosis of liver fibrosis owing to the easy availability in field practice. Among these tools, the FIB-4 index is a simple formula used for predicting liver fibrosis based on standard biochemical values (platelet count, AST and ALT) and age, and is demonstrated to be highly helpful for predicting advanced liver fibrosis (19)(20)(21)(22) (23,24). The aims of the present study were to examine the relationship between preoperative FIB-4 index and background liver fibrosis in non-tumor parts obtained from extracted surgical specimens and to investigate whether the preoperative FIB-4 index can be a useful predictor for NBNC-HCC patients treated with SR.…”

Section: Introductionmentioning

confidence: 99%

Clinical significance of the FIB-4 index for non-B non-C hepatocellular carcinoma treated with surgical resection

et al. 2014

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Abstract. The aims of the present study were to examine the relationship between the preoperative FIB-4 index and background liver fibrosis in non-tumor parts obtained from surgical specimens and to investigate whether the FIB-4 index can be a useful predictor for non-B non-C hepatocellular carcinoma (NBNC-HCC) patients treated with surgical resection (SR). A total of 118 patients with NBNC-HCC treated with SR with curative intent were analyzed. Receiver operating characteristic (ROC) curve analysis was performed for calculating the area under the ROC (AUROC) for the FIB-4 index, aspartate aminotransferase (AST) to platelet ratio index, AST to alanine aminotransferase ratio, serum albumin, total bilirubin and platelet count for cirrhosis. We also examined predictors linked to overall survival (OS) and recurrence-free survival (RFS) after SR. The mean patient age was 68.9±9.0 years (93 males and 25 females) with a median observation period of 3.2 years. In extracted surgical specimens, background liver cirrhosis (F4) was observed in 39 patients (33.1%). The mean maximum tumor size was 5.7±3.2 cm. The mean body mass index was 24.3±3.9 kg/m 2 . The FIB-4 index yielded the highest AUROC for cirrhosis with a level of 0.887 at an optimal cut-off value of 2.97 (sensitivity, 92.3; specificity, 69.6%). In the multivariate analysis, serum α-fetoprotein >40 ng/ml (P=0.026) was the only significant independent predictor linked to OS, while tumor number (P=0.002) and FIB-4 index >2.97 (P=0.044) were significant factors linked to RFS. In conclusion, preoperative FIB-4 index can be a useful predictor for NBNC-HCC patients who undergo SR. IntroductionHepatocellular carcinoma (HCC) is the fifth most common cancer in the world and the third most common cause of cancerrelated death (1-3). Although most cases of this malignancy are associated with viral infections such as hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, a substantial proportion of HCC patients are negative for markers of HBV surface antigen (HBsAg) and HCV antibody (HCVAb) [non-B non-C HCC (NBNC-HCC)]. The frequency of NBNC-HCC has been reported to range from 5 to 15%, and the number of NBNC-HCC patients in Japan has recently been gradually increasing (4-7). It is noteworthy that the proportion of NBNC-HCC patients was ~30% in 2011, 2012 and 2013 in our hospital (1).Curative therapies for HCC consist of liver transplantation, surgical resection (SR) and radiofrequency ablation (RFA) (1-7). The clinical outcome of HCC patients undergoing these therapies has improved substantially in recent years due to their advances. However, HCC often recurs even after curative therapies, leading to high mortality. Recurrence only occurs at intrahepatic sites in 68-96% of patients (1,(8)(9)(10). Hence, the identification of predictive factors and effective management of HCC recurrence are essential for improving survival, even after curative treatment.Recently, several noninvasive tools have been introduced to evaluate the degree of hepatic fibrosis in patients with...

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Section: Introductionmentioning

confidence: 99%

Clinical significance of the FIB-4 index for non-B non-C hepatocellular carcinoma treated with surgical resection

et al. 2014

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“…Although several noninvasive serum markers such as ICG15, FIB-4 index and APRI are associated with clinical outcomes in HCV-related HCC patients, no reports have assessed the impact of preoperative GSA index on clinical outcomes in HCV-related HCC patients treated with SR (21)(22)(23)(24). Hence, we conducted the current analysis.…”

Section: Discussionmentioning

confidence: 99%

Clinical implication of the preoperative GSA index in 99mTc-GSA scintigraphy in hepatitis C virus-related hepatocellular carcinoma

et al. 2014

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Abstract. We aimed to examine the relationship between the preoperative GSA index [uptake ratio of the liver to the liver plus heart at 15 min (LHL15) to uptake ratio of the heart at 15 min to that at 3 min (HH15) ratio] calculated from 99m Tc-labeled diethylene triamine pentaacetate-galactosyl human serum albumin ( 99m Tc-GSA) scintigraphy and background liver fibrosis and to investigate whether the GSA index can be a useful predictor in hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) patients treated with surgical resection (SR). A total of 213 HCV-related HCC patients were analyzed. Receiver operating characteristic (ROC) curve analysis was performed for calculating the area under the ROC (AUROC) for nine noninvasive parameters including GSA index, indocyanine green retention at 15 min, aspartate aminotransferase (AST) to platelet ratio index, FIB-4 index, AST to alanine aminotransferase ratio, serum albumin, total bilirubin, platelet count and prothrombin time for cirrhosis. We also examined predictive factors associated with overall survival (OS) and recurrence-free survival (RFS) after SR in univariate and multivariate analyses. There were 153 males and 60 females with the mean age of 69.9 years. The median observation periods were 2.8 years. The mean maximum tumor size was 4.1 cm. HH15 ranged from 0.452 to 0.897. LHL15 ranged from 0.669 to 0.982. The mean value of the GSA index was 1.41. Among the nine parameters, the GSA index yielded the highest AUROC for cirrhosis with a level of 0.786 at an optimal cut-off value of 1.37 (sensitivity, 65.9%; specificity, 79.0%). In multivariate analyses, the GSA index was an independent predictor (P<0.001) linked to RFS and it had a marginal significance in terms of OS (P= 0.074). In conclusion, the preoperative GSA index can be a useful predictor in HCV-related HCC patients treated with SR. IntroductionHepatocellular carcinoma (HCC) is the fifth most common cancer in the world and the third most common cause of cancer-related death (1-3). In Japan, most HCC cases are due to chronic hepatitis C virus (HCV) infection (3). Curative therapies for HCC consist of liver transplantation, surgical resection (SR) and radiofrequency ablation (RFA) (1-3). The clinical outcome of HCC patients undergoing these therapies has improved substantially in recent years due to treatment advances. However, HCC often recurs even after curative therapies, leading to high mortality, and the pattern of HCC recurrence is frequently ectopic as well as local. The identification of predictive factors and effective management of HCC recurrence are essential for improving survival, even after curative treatment (1-5). Tc-labeled diethylene triamine pentaacetate-galactosyl human serum albumin ( 99m Tc-GSA) is a radiopharmaceutical that binds specifically to the hepatic asialoglycoprotein receptor (ASGP-R). Expression of ASGP-R has been reported to be decreased in patients with chronic liver damage and thus it has been widely used to assess liver functional reserve in various pathologica...

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“…Aspartate aminotransferase(AST)-to-platelet ratio index (APRI) is a simple and feasible test validated in assessing the stage of fibrosis and in predicting prognosis for patients with chronic hepatitis (11,12).APRI shows reliable discriminative ability for predicting not only overall survival of HCC patients, but also tumor recurrence (13).APRI was also found to be a prognostic biomarker in small HCC patients after RFA therapy and surgical resection (14,15).…”

Section: Issn: 2320-5407mentioning

confidence: 99%

Aspartate Aminotransferase to Platelet Ratio Index Versus Neutrophil to Lymphocyte Ratio for Prediction of Post Radiofrequency Ablation Recurrence of Hepatocellular Carcinoma.

Sallam.¹,

Fawzy.²,

Elsadek.³

2017

IJAR

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Background & Aims:Tumor recurrence after curative radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) is common. The burden of frequent post-ablation investigations especially triphasic computerized tomography (TCT) is high. We investigated whether post ablation measurement of aspartate aminotransferase to platelet ratio index (APRI) and neutrophil to lymphocyte ratio (NLR) as simple and cheap biomarkers can precisely predict HCC recurrence and which of them is more valuable. Methods: In this retrospective study, the demographic, clinical, laboratory and imaging data of 42 HCC patients treated with RFA were statistically analyzed. Patients were classified into two groups; those with HCC recurrence (group I) and those without (group II). In order to test the value of baseline NLR versus that of APRI in predicting tumor recurrence and compare both to alfa fetoprotein (AFP), we used receiver operating curve (ROC) statistics. Results: Mean values of AST, Platelets count, APRI, NLR and AFP showed significant correlation with HCC recurrence. Using logistic regression analysis, NLR was the only independent risk factor predicting HCC recurrence. NLR had the highest sensitivity and specificity for prediction of HCC recurrence (90.9 % and 85%) followed by that of AFP (86.4 % and 75%), and lastly by that of APRI (72.7% and 70%). Conclusion: NLR is a promising, simple and cheap surrogate marker for prediction of HCC recurrence after radiofrequency ablation, and is far more significant than APRI. .

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Preoperative Aspartate Aminotransferase to Platelet Ratio is an Independent Prognostic Factor for Hepatitis B-Induced Hepatocellular Carcinoma After Hepatic Resection

Abstract: Elevated platelets based inflammatory indices, especially APRI, was associated with adverse characteristic features and poor prognosis in HCC, especially for patients with HBV infection or cirrhosis. Antiplatelet treatment may represent a potential therapy for HBV-induced HCC recurrence.

Cited by 98 publications

References 29 publications

Clinical significance of the FIB-4 index for non-B non-C hepatocellular carcinoma treated with surgical resection

Clinical significance of the FIB-4 index for non-B non-C hepatocellular carcinoma treated with surgical resection

Clinical implication of the preoperative GSA index in 99mTc-GSA scintigraphy in hepatitis C virus-related hepatocellular carcinoma

Aspartate Aminotransferase to Platelet Ratio Index Versus Neutrophil to Lymphocyte Ratio for Prediction of Post Radiofrequency Ablation Recurrence of Hepatocellular Carcinoma.

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