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Simple models based on gamma-glutamyl transpeptidase and platelets for predicting survival in hepatitis B-associated hepatocellular carcinoma.

Pang Q, Bi JB, Wang ZX, Xu XS, Qu K, Miao RC, Chen W, Zhou YY, Liu C - Onco Targets Ther (2016)

Bottom Line: GPR and S-index were both found to be significantly associated with survival by univariate log-rank test.Multivariate analysis identified tumor size ≥5 and high level of GPR, but not high Barcelona Clinic Liver Cancer stage or S-index, as independent factors for predicting poor overall survival and recurrence-free survival.The GPR is an effective preoperative predictor for outcomes in hepatitis B-associated HCC.

View Article: PubMed Central - PubMed

Affiliation: Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi Province, People's Republic of China.

ABSTRACT

Background: Several hepatic cirrhosis-derived noninvasive models have been developed to predict the incidence and outcomes of hepatocellular carcinoma (HCC). We aimed to investigate the prognostic significance of the two novel established cirrhosis-associated models based on gamma-glutamyl transpeptidase (GGT) and platelets in hepatitis B-associated HCC.

Methods: We retrospectively evaluated 182 HCC patients with positive hepatitis B surface antigen who received radical therapy at a single institution between 2002 and 2012. Laboratory data prior to operation were collected to calculate the GGT to platelets ratio (GPR) and the S-index. Predictive factors associated with overall survival and recurrence-free survival were assessed using log-rank test and multivariate Cox analysis. Additional analyses were performed after patients were stratified based on cirrhosis status, tumor size, therapy methods, and so forth, to investigate the prognostic significance in different subgroups.

Results: During a median follow-up time of 45.0 months, a total of 88 (48.4%) patients died and 79 (43.4%) patients recurred. The cut-off points for GPR and S-index in predicting death were determined to be 0.76 and 0.56, respectively. Compared with patients with a lower GPR, those with GPR ≥0.76 had a higher probability of cirrhosis and a larger tumor (both P<0.05). GPR and S-index were both found to be significantly associated with survival by univariate log-rank test. Multivariate analysis identified tumor size ≥5 and high level of GPR, but not high Barcelona Clinic Liver Cancer stage or S-index, as independent factors for predicting poor overall survival and recurrence-free survival.

Conclusion: The GPR is an effective preoperative predictor for outcomes in hepatitis B-associated HCC.

No MeSH data available.


Related in: MedlinePlus

Forest plots based on the results of subgroup analyses of the GPR for overall survival (A) and recurrence-free survival (B) in patients with hepatitis B-related HCC.Note: The subgroup analyses were based on the following variables: age, level of AFP, status of cirrhosis, ascites, tumor size, tumor number, vascular invasion, BCLC stage, and treatment method.Abbreviations: AFP, alpha-fetoprotein; BCLC, Barcelona Clinic Liver Cancer; CI, confidence interval; GPR, gamma-glutamyl transpeptidase to platelet ratio; HCC, hepatocellular carcinoma; HR, hazard ratio; RFA, radiofrequency ablation.
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f5-ott-9-2099: Forest plots based on the results of subgroup analyses of the GPR for overall survival (A) and recurrence-free survival (B) in patients with hepatitis B-related HCC.Note: The subgroup analyses were based on the following variables: age, level of AFP, status of cirrhosis, ascites, tumor size, tumor number, vascular invasion, BCLC stage, and treatment method.Abbreviations: AFP, alpha-fetoprotein; BCLC, Barcelona Clinic Liver Cancer; CI, confidence interval; GPR, gamma-glutamyl transpeptidase to platelet ratio; HCC, hepatocellular carcinoma; HR, hazard ratio; RFA, radiofrequency ablation.

Mentions: As shown in Table 1, the GPR was significantly different in patients with different status of cirrhosis, different tumor size, and on different treatments. Our current results and previous studies showed that age, AFP, cirrhosis, ascites, tumor size, tumor number, vascular invasion, and methods of treatment were significant prognostic factors of HCC. Therefore, these factors might be critical confounders in our cohort. To investigate whether they influenced the significance of GPR, we performed subgroup analyses accordingly, and the forest plots based on the results are shown in Figure 5. GPR was a useful indicator of OS and RFS in patients without cirrhosis, but not in patients with cirrhosis. Patients with a high level of GPR had a significantly poor survival, no matter what kinds of treatments they received and whether they had ascites. In addition, GPR was found to be more significant in the subgroups of older age and decreased level of AFP.


Simple models based on gamma-glutamyl transpeptidase and platelets for predicting survival in hepatitis B-associated hepatocellular carcinoma.

Pang Q, Bi JB, Wang ZX, Xu XS, Qu K, Miao RC, Chen W, Zhou YY, Liu C - Onco Targets Ther (2016)

Forest plots based on the results of subgroup analyses of the GPR for overall survival (A) and recurrence-free survival (B) in patients with hepatitis B-related HCC.Note: The subgroup analyses were based on the following variables: age, level of AFP, status of cirrhosis, ascites, tumor size, tumor number, vascular invasion, BCLC stage, and treatment method.Abbreviations: AFP, alpha-fetoprotein; BCLC, Barcelona Clinic Liver Cancer; CI, confidence interval; GPR, gamma-glutamyl transpeptidase to platelet ratio; HCC, hepatocellular carcinoma; HR, hazard ratio; RFA, radiofrequency ablation.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4835119&req=5

f5-ott-9-2099: Forest plots based on the results of subgroup analyses of the GPR for overall survival (A) and recurrence-free survival (B) in patients with hepatitis B-related HCC.Note: The subgroup analyses were based on the following variables: age, level of AFP, status of cirrhosis, ascites, tumor size, tumor number, vascular invasion, BCLC stage, and treatment method.Abbreviations: AFP, alpha-fetoprotein; BCLC, Barcelona Clinic Liver Cancer; CI, confidence interval; GPR, gamma-glutamyl transpeptidase to platelet ratio; HCC, hepatocellular carcinoma; HR, hazard ratio; RFA, radiofrequency ablation.
Mentions: As shown in Table 1, the GPR was significantly different in patients with different status of cirrhosis, different tumor size, and on different treatments. Our current results and previous studies showed that age, AFP, cirrhosis, ascites, tumor size, tumor number, vascular invasion, and methods of treatment were significant prognostic factors of HCC. Therefore, these factors might be critical confounders in our cohort. To investigate whether they influenced the significance of GPR, we performed subgroup analyses accordingly, and the forest plots based on the results are shown in Figure 5. GPR was a useful indicator of OS and RFS in patients without cirrhosis, but not in patients with cirrhosis. Patients with a high level of GPR had a significantly poor survival, no matter what kinds of treatments they received and whether they had ascites. In addition, GPR was found to be more significant in the subgroups of older age and decreased level of AFP.

Bottom Line: GPR and S-index were both found to be significantly associated with survival by univariate log-rank test.Multivariate analysis identified tumor size ≥5 and high level of GPR, but not high Barcelona Clinic Liver Cancer stage or S-index, as independent factors for predicting poor overall survival and recurrence-free survival.The GPR is an effective preoperative predictor for outcomes in hepatitis B-associated HCC.

View Article: PubMed Central - PubMed

Affiliation: Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi Province, People's Republic of China.

ABSTRACT

Background: Several hepatic cirrhosis-derived noninvasive models have been developed to predict the incidence and outcomes of hepatocellular carcinoma (HCC). We aimed to investigate the prognostic significance of the two novel established cirrhosis-associated models based on gamma-glutamyl transpeptidase (GGT) and platelets in hepatitis B-associated HCC.

Methods: We retrospectively evaluated 182 HCC patients with positive hepatitis B surface antigen who received radical therapy at a single institution between 2002 and 2012. Laboratory data prior to operation were collected to calculate the GGT to platelets ratio (GPR) and the S-index. Predictive factors associated with overall survival and recurrence-free survival were assessed using log-rank test and multivariate Cox analysis. Additional analyses were performed after patients were stratified based on cirrhosis status, tumor size, therapy methods, and so forth, to investigate the prognostic significance in different subgroups.

Results: During a median follow-up time of 45.0 months, a total of 88 (48.4%) patients died and 79 (43.4%) patients recurred. The cut-off points for GPR and S-index in predicting death were determined to be 0.76 and 0.56, respectively. Compared with patients with a lower GPR, those with GPR ≥0.76 had a higher probability of cirrhosis and a larger tumor (both P<0.05). GPR and S-index were both found to be significantly associated with survival by univariate log-rank test. Multivariate analysis identified tumor size ≥5 and high level of GPR, but not high Barcelona Clinic Liver Cancer stage or S-index, as independent factors for predicting poor overall survival and recurrence-free survival.

Conclusion: The GPR is an effective preoperative predictor for outcomes in hepatitis B-associated HCC.

No MeSH data available.


Related in: MedlinePlus