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A high value of serum des-γ-carboxy prothrombin before hepatocellular carcinoma treatment can be associated with long-term liver dysfunction after treatment

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Transcatheter arterial chemoembolization (TACE) is an effective treatment for hepatocellular carcinoma (HCC), but it sometimes makes liver function worse. The pre-TACE prediction of liver dysfunction after TACE would be helpful to avoid long-term liver dysfunction.

Methods

We performed a case–control study in 100 HCC patients who underwent TACE at Kobe University Hospital. Urinary/blood biochemical examinations were performed before TACE. As an indicator of liver function, Child’s score was also evaluated before and 3 months after TACE. Cases with and without an increase of 2 points or more in the Child’s score were compared, and independent risk factors were statistically examined. A pre-TACE predictive model of an increase of 2 points or more in the Child’s score after TACE was developed using logistic regression.

Results

Univariate analyses showed that des-γ-carboxy prothrombin (DCP) and lactate dehydrogenase (LDH) before TACE were significantly higher in the Child’s score-deteriorated group than in the group with no deterioration (p = 0.036 and 0.003, respectively). All possible multivariate regressions showed that DCP (p = 0.003) and LDH (p = 0.002) were independent factors determining the deterioration of Child’s class. A predictive model was developed, as follows: exp(0.014 × LDH + 0.572 × ln(DCP) − 8.655)/(1 + exp(0.014 × LDH + 0.572 × ln(DCP) − 8.655)). The model discriminated well, with AUC being 0.837 (95 % confidence interval [CI] 0.662–1.000). The optimal cut-off point was 0.073, and the sensitivity and specificity were 90.9 and 69.7 %, respectively.

Conclusions

High values of DCP and LDH before TACE were associated with the long-term deterioration of liver function. Our pre-therapeutic prediction model could be useful to identify high-risk cases.

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Abbreviations

HCC:

Hepatocellular carcinoma

RFA:

Radiofrequency ablation

PEI:

Percutaneous ethanol injection

TACE:

Transcatheter arterial chemoembolization

CT:

Computed tomography

DCP:

Des-γ-carboxy prothrombin

IBW:

Ideal body weight

BMI:

Body mass index

TNM:

Tumor node metastasis

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

LDH:

Lactate dehydrogenase

γ-GTP:

γ-Glutamyltranspeptidase

T-Bil:

Total bilirubin

ChE:

Cholinesterase

BTR:

Branched-chain amino acid/tyrosine ratio

PT:

Prothrombin time

Plt:

Platelets

FPG:

Fasting plasma glucose

IRI:

Immunoreactive insulin

HbA1c:

Hemoglobin A1c

HA:

Hyaluronic acid

AFP:

Alpha fetoprotein

ICG:

Indocyanine green

3-MH:

3-Methylhistidine

CHI:

Creatinine height index

VIF:

Variance inflation factor

AIC:

Akaike’s information criterion

AUC:

Area under ROC

EMT:

Epithelial to mesenchymal transition

BCAA:

Branched chain amino acids

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Acknowledgments

We thank the nurses and our colleagues in the Department of Gastroenterology and Gastroenterology Ward at Kobe University Hospital for their participation and support in the study. We also thank the dietitians of the department for their excellent technical assistance in this study.

Conflict of interest

We declare that we have no conflicts of interest.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Masaya Saito, Yasushi Seo, Yoshihiko Yano, Akira Miki, Masaru Yoshida & Takeshi Azuma

  2. Center for Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan

    Yoshihiko Yano

  3. Division of Metabolomics Research, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan

    Masaru Yoshida

Authors
  1. Masaya Saito
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  2. Yasushi Seo
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  3. Yoshihiko Yano
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  4. Akira Miki
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Correspondence to Takeshi Azuma.

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Saito, M., Seo, Y., Yano, Y. et al. A high value of serum des-γ-carboxy prothrombin before hepatocellular carcinoma treatment can be associated with long-term liver dysfunction after treatment. J Gastroenterol 47, 1134–1142 (2012). https://doi.org/10.1007/s00535-012-0577-0

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  • DOI: https://doi.org/10.1007/s00535-012-0577-0

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