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World J Gastroenterol. May 7, 2012; 18(17): 2005-2008
Published online May 7, 2012. doi: 10.3748/wjg.v18.i17.2005
Branched-chain amino acids to tyrosine ratio value as a potential prognostic factor for hepatocellular carcinoma
Toru Ishikawa
Toru Ishikawa, Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, 280-7 Teraji, Niigata 950-1104, Japan
Author contributions: Ishikawa T contributed solely to this manuscript.
Correspondence to: Toru Ishikawa, MD, Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, 280-7 Teraji, Niigata 950-1104, Japan. toruishi@ngt.saiseikai.or.jp
Telephone: +81-25-2336161 Fax: +81-25-2338880
Received: July 19, 2011
Revised: September 28, 2011
Accepted: October 27, 2011
Published online: May 7, 2012
Abstract

The prognosis of hepatocellular carcinoma (HCC) depends on tumor extension as well as hepatic function. Hepatic functional reserve is recognized as a factor affecting survival in the treatment of HCC; the Child-Pugh classification system is the most extensively used method for assessing hepatic functional reserve in patients with chronic liver disease, using serum albumin level to achieve accurate assessment of the status of protein metabolism. However, insufficient attention has been given to the status of amino acid (AA) metabolism in chronic liver disease and HCC. Fischer’s ratio is the molar ratio of branched-chain AAs (BCAAs: leucine, valine, isoleucine) to aromatic AAs (phenylalanine, tyrosine) and is important for assessing liver metabolism, hepatic functional reserve and the severity of liver dysfunction. Although this ratio is difficult to determine in clinical situations, BCAAs/tyrosine molar concentration ratio (BTR) has been proposed as a simpler substitute. BTR correlates with various liver function examinations, including markers of hepatic fibrosis, hepatic blood flow and hepatocyte function, and can thus be considered as reflecting the degree of hepatic impairment. This manuscript examines the literature to clarify whether BTR can serve as a prognostic factor for treatment of HCC.

Keywords: Branched-chain amino acids to tyrosine ratio, Fischer’s ratio, Prognostic factor, Hepatocellular carcinoma