Retrospective Study
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World J Gastroenterol. Aug 21, 2014; 20(31): 10944-10952
Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10944
Model based on γ-glutamyltransferase and alkaline phosphatase for hepatocellular carcinoma prognosis
Xin-Sen Xu, Yong Wan, Si-Dong Song, Wei Chen, Run-Chen Miao, Yan-Yan Zhou, Ling-Qiang Zhang, Kai Qu, Si-Nan Liu, Yue-Lang Zhang, Ya-Feng Dong, Chang Liu
Xin-Sen Xu, Yong Wan, Si-Dong Song, Wei Chen, Run-Chen Miao, Yan-Yan Zhou, Ling-Qiang Zhang, Kai Qu, Si-Nan Liu, Chang Liu, Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Yue-Lang Zhang, Department of Radiology, the First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Ya-Feng Dong, Department of Obstetrics and Gynecology, University of Kansas School of Medicine, Kansas City, KS 66160, United States
Author contributions: Xu XS designed the research and wrote this paper; Wan Y and Song SD performed the statistical analysis; Chen W, Miao RC, Zhou YY and Zhang LQ were involved in collecting patient data; Qu K and Liu SN took part in literature searches; Zhang YL and Dong YF edited the manuscript; Liu C designed the research.
Supported by National natural science foundation of China, No. 81272644 and No. 81201549
Correspondence to: Chang Liu, MD, PhD, Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi’an Jiaotong University, No. 277, West Yanta Road, Xi’an 710061, Shaanxi Province, China. liuchangdoctor@163.com
Telephone: +86-29-82654746 Fax: +86-29-82654746
Received: January 24, 2014
Revised: April 1, 2014
Accepted: May 19, 2014
Published online: August 21, 2014
Abstract

AIM: To determine the prognostic value of alkaline phosphatase (ALP) and γ-glutamyltransferase (GGT) for hepatocellular carcinoma (HCC) .

METHODS: We analyzed the outcome of 172 HCC patients who underwent liver resection. Receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off value of ALP and GGT. Then, preoperative risk factors for survival were evaluated by multivariate analysis. Based on the significant factors, a prognostic score model was established.

RESULTS: By ROC curve analysis, ALP > 120 U/L and GGT > 115 U/L were considered elevated. Overall survival (OS) and tumor-free survival (TFS) for patients with elevated ALP and GGT were significantly worse than for patients with ALP and GGT within the normal range. Multivariate analysis showed that the elevated levels of ALP, GGT and tumor size were independent prognostic factors. Giving each positive factor as a score of 1, we established a preoperative prognostic score model. The 5-year OS for patients with a score of 0, 1, 2 and 3 were 84.0%, 45.9%, 44.1% and 0%, respectively, while the TFS was 80.6%, 40.0%, 38.8% and 0%, respectively. When combining patients with scores of 1 and 2 into the middle risk group, and patients with scores of 0 and 3 into the low-risk and high-risk groups, respectively, different outcomes would be significantly distinguished by the risk groups.

CONCLUSION: Elevated ALP and GGT levels were risk predictors in HCC patients. Our prognostic model might vary the outcomes of patients from different risk groups.

Keywords: Alkaline phosphatase, γ-Glutamyltransferase, Prognosis, Hepatocellular carcinoma

Core tip: To determine the optimal cut-off value of alkaline phosphatase (ALP) and γ-glutamyltransferase (GGT) to predict hepatocellular carcinoma (HCC) prognosis after liver resection, and to establish a scoring model, we analyzed the outcome of 172 HCC patients who underwent liver resection. Receiver operating characteristic curve analysis was performed to determine the cut-off value of ALP and GGT. Preoperative risk factors for survival were evaluated by multivariate analysis. Based on the significant factors, a prognostic scoring model was established. Our model might affect the outcome of patients in different risk groups, and was superior to the traditional risk markers.