Advertisement

Tumor Biology

, Volume 37, Issue 3, pp 2951–2959 | Cite as

Alanine aminotransferase to hemoglobin ratio is an indicator for disease progression for hepatocellular carcinoma patients receiving transcatheter arterial chemoembolization

  • Zhi-Huan Lin
  • Xing Li
  • Ying-Fen Hong
  • Xiao-Kun Ma
  • Dong-Hao Wu
  • MingSheng Huang
  • Zhan-Hong Chen
  • Jie Chen
  • Min Dong
  • Li Wei
  • Tian-Tian Wang
  • Dan-Yun Ruan
  • Ze-Xiao Lin
  • Xiang Zhong
  • Yan-Fang Xing
  • Jing-Yun Wen
  • Xiang-Yuan Wu
  • Qu Lin
Original Article

Abstract

The prognosis of hepatocellular carcinoma (HCC) patients receiving transcatheter arterial chemoembolization (TACE) is far from being identified. The present study aimed to assess the role of blood cell counts, routine liver function tests, and alanine aminotransferase to hemoglobin ratio (AHR) in predicting the progression-free survival (PFS) of these patients. A total of 243 HCC patients receiving TACE were analyzed retrospectively. Cancer of the Liver Italian Program (CLIP) score system was indentified to be the best score system for this patient subgroup according to the Akaike information criterion (AIC) index and linear trend χ 2. Then, prognostic value of parameters was determined by integration into the CLIP score system. As a result, AHR was confirmed to be an independent predictor for the PFS of HCC patients receiving TACE (p = 0.001) with the other parameters failing to reach statistical significance. Moreover, AHR improved the performance of CLIP by adjusting into it, thus improving its discriminatory ability. AHR defined ≤0.4583 as low level and >0.4583 as high level. And, patients were also dichotomized into two groups accordingly. HCC patients receiving TACE with low AHR presented higher 1 year DCR (41.9 vs 18.1 %) compared with patients with high AHR levels. Furthermore, AHR level was associated with prognostic factors such as lower ALP, total bilirubin, and portal vein thrombosis. In summary, the present study firstly indentified AHR as an independent prognostic factor in HCC patients receiving TACE. The subgroup of HCC patients with lower AHR presented preferable disease control and were the idealistic candidates for TACE.

Keywords

Alanine aminotransferase to hemoglobin ratio Hepatocellular carcinoma Transcatheter arterial chemoembolization Prognosis Progression-free survival 

Notes

Conflicts of interest

None

Financial support

This work was supported by grants from the National Natural Science Foundation of China (Nos. 81372374, 81172193, 81402426, and 81402509), China Postdoctoral Science foundation (2014M560689) and the Natural Science Foundation of Guangdong (No. 2014A030313146).

Supplementary material

13277_2015_4082_Fig3_ESM.jpg (4.9 mb)
Supplementary Figure 1

(JPEG 5061 kb)

References

  1. 1.
    Lencioni R. Loco-regional treatment of hepatocellular carcinoma. Hepatology. 2010;52:762–73.CrossRefPubMedGoogle Scholar
  2. 2.
    Matsuda M, Omata F, Fuwa S, Saida Y, Suzuki S, Uemura M, et al. Prognosis of patients with hepatocellular carcinoma treated solely with transcatheter arterial chemoembolization: risk factors for one-year recurrence and two-year mortality (preliminary data). Intern Med. 2013;52:847–53.CrossRefPubMedGoogle Scholar
  3. 3.
    Xiong ZP, Huang F, Lu MH. Association between insulin-like growth factor-2 expression and prognosis after transcatheter arterial chemoembolization and octreotide in patients with hepatocellular carcinoma. Asian Pac J Cancer Prev. 2012;13:3191–4.CrossRefPubMedGoogle Scholar
  4. 4.
    Biolato M, Miele L, Vero V, Racco S, Di Stasi C, Iezzi R, et al. Hepatocellular carcinoma treated by conventional transarterial chemoembolization in field-practice: serum sodium predicts survival. World J Gastroenterol. 2014;20:8158–65.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Yodono H, Matsuo K, Shinohara A. A retrospective comparative study of epirubicin-lipiodol emulsion and cisplatin-lipiodol suspension for use with transcatheter arterial chemoembolization for treatment of hepatocellular carcinoma. Anticancer Drugs. 2011;22:277–82.CrossRefPubMedGoogle Scholar
  6. 6.
    Song J, Wang LZ, Li X, Jiang TP, An TZ, Xu M, et al. Polymorphisms of vascular endothelial growth factor on prognosis in hepatocellular carcinoma patients receiving transcatheter arterial chemoembolization treatment. Genet Mol Res. 2014;13:8946–53.CrossRefPubMedGoogle Scholar
  7. 7.
    Li X, Chen ZH, Ma XK, Chen J, Wu DH, Lin Q, et al. Neutrophil-to-lymphocyte ratio acts as a prognostic factor for patients with advanced hepatocellular carcinoma. Tumour Biol. 2014;35:11057–63.CrossRefPubMedGoogle Scholar
  8. 8.
    Li X, Chen ZH, Xing YF, Wang TT, Wu DH, Wen JY, et al. Platelet-to-lymphocyte ratio acts as a prognostic factor for patients with advanced hepatocellular carcinoma. Tumour Biol. 2015;36:2263–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Li X, Dong M, Lin Q, Chen ZH, Ma XK, Xing YF, et al. Comparison of current staging systems for advanced hepatocellular carcinoma not amendable to locoregional therapy as inclusion criteria for clinical trials. Asia Pac J Clin Oncol. 2013;9:86–92.CrossRefPubMedGoogle Scholar
  10. 10.
    Reig M, Rimola J, Torres F, Darnell A, Rodriguez-Lope C, Forner A, et al. Postprogression survival of patients with advanced hepatocellular carcinoma: rationale for second-line trial design. Hepatology. 2013;58:2023–31.CrossRefPubMedGoogle Scholar
  11. 11.
    Shim JH, Park JW, Kim JH, An M, Kong SY, Nam BH, et al. Association between increment of serum VEGF level and prognosis after transcatheter arterial chemoembolization in hepatocellular carcinoma patients. Cancer Sci. 2008;99:2037–44.PubMedGoogle Scholar
  12. 12.
    Borzio M, Fornari F, De Sio I, Andriulli A, Terracciano F, Parisi G, et al. Adherence to American Association for the Study of Liver Diseases guidelines for the management of hepatocellular carcinoma: results of an Italian field practice multicenter study. Future Oncol. 2013;9:283–94.CrossRefPubMedGoogle Scholar
  13. 13.
    Lee MH, Yang HI, Liu J, Batrla-Utermann R, Jen CL, Iloeje UH, et al. Prediction models of long-term cirrhosis and hepatocellular carcinoma risk in chronic hepatitis B patients: risk scores integrating host and virus profiles. Hepatology. 2013;58:546–54.CrossRefPubMedGoogle Scholar
  14. 14.
    Feier D, Lupsor Platon M, Stefanescu H, Badea R. Transient elastography for the detection of hepatocellular carcinoma in viral c liver cirrhosis. Is there something else than increased liver stiffness? J Gastrointestin Liver Dis. 2013;22:283–9.PubMedGoogle Scholar
  15. 15.
    Finkelmeier F, Bettinger D, Koberle V, Schultheiss M, Zeuzem S, Kronenberger B, et al. Single measurement of hemoglobin predicts outcome of HCC patients. Med Oncol. 2014;31:806.CrossRefPubMedGoogle Scholar
  16. 16.
    Eldeeb H, Abdel-Khalk S. Does treatment interruption and baseline hemoglobin affect overall survival in early laryngeal cancer treated with radical radiotherapy? 10 years follow up. J BUON. 2014;19:124–9.PubMedGoogle Scholar
  17. 17.
    Bruix J, Gores GJ, Mazzaferro V. Hepatocellular carcinoma: clinical frontiers and perspectives. Gut. 2014;63:844–55.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020–2.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Aleksandrova K, Boeing H, Nothlings U, Jenab M, Fedirko V, Kaaks R, et al. Inflammatory and metabolic biomarkers and risk of liver and biliary tract cancer. Hepatology. 2014;60:858–71.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Kudo M, Chung H, Osaki Y. Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the japan integrated staging score (JIS score). J Gastroenterol. 2003;38:207–15.CrossRefPubMedGoogle Scholar
  21. 21.
    Basar O, Yimaz B, Ekiz F, Ginis Z, Altinbas A, Aktas B, et al. Non-invasive tests in prediction of liver fibrosis in chronic hepatitis B and comparison with post-antiviral treatment results. Clin Res Hepatol Gastroenterol. 2013;37:152–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Suh SW, Lee JM, You T, Choi YR, Yi NJ, Lee KW, et al. Hepatic venous congestion in living donor grafts in liver transplantation: is there an effect on hepatocellular carcinoma recurrence? Liver Transpl. 2014;20:784–90.CrossRefPubMedGoogle Scholar
  23. 23.
    Grimm M, Lazariotou M. Clinical relevance of a new pre-treatment laboratory prognostic index in patients with oral squamous cell carcinoma. Med Oncol. 2012;29:1435–47.CrossRefPubMedGoogle Scholar
  24. 24.
    Nakamura T, Grimer R, Gaston C, Carter S, Tillman R, Abudu A, et al. The relationship between pretreatment anaemia and survival in patients with adult soft tissue sarcoma. J Orthop Sci. 2013;18:987–93.CrossRefPubMedGoogle Scholar
  25. 25.
    Cetin B, Afsar B, Deger SM, Gonul II, Gumusay O, Ozet A, et al. Association between hemoglobin, calcium, and lactate dehydrogenase variability and mortality among metastatic renal cell carcinoma. Int Urol Nephrol. 2014;46:1081–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Mascanfroni ID, Takenaka MC, Yeste A, Patel B, Wu Y, Kenison JE, et al. Metabolic control of type 1 regulatory T cell differentiation by AHR and HIF1-alpha. Nat Med. 2015;21:638–46.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2015

Authors and Affiliations

  • Zhi-Huan Lin
    • 1
  • Xing Li
    • 1
  • Ying-Fen Hong
    • 1
  • Xiao-Kun Ma
    • 1
  • Dong-Hao Wu
    • 1
  • MingSheng Huang
    • 2
  • Zhan-Hong Chen
    • 1
  • Jie Chen
    • 1
  • Min Dong
    • 1
  • Li Wei
    • 1
  • Tian-Tian Wang
    • 1
  • Dan-Yun Ruan
    • 1
  • Ze-Xiao Lin
    • 1
  • Xiang Zhong
    • 3
  • Yan-Fang Xing
    • 4
  • Jing-Yun Wen
    • 1
  • Xiang-Yuan Wu
    • 1
  • Qu Lin
    • 1
  1. 1.Department of Medical OncologyThe Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
  2. 2.Department of RadiologyThe Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
  3. 3.Department of Medical OncologyShenzhen People’s HospitalShenzhenChina
  4. 4.Department of NephrologyThe Third Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina

Personalised recommendations