title: Serum alanine aminotransferase levels and survival after hepatectomy in patients with hepatocellular carcinoma and hepatitis C virus-associated liver cirrhosis.
abstract: We examined whether sustained alleviation of inflammation as monitored by serum alanine aminotransferase (ALT) levels was associated with longer survival in hepatectomized hepatocellular carcinoma (HCC) patients with hepatitis C virus-associated liver cirrhosis (HCV-LC). Thirty-four hepatectomized patients with HCV-LC and HCC as a single nodule, and for whom more than 5 years had elapsed after the hepatectomy, were studied. They had no histologic evidence of portal or hepatic vein invasion. They were subdivided into two groups according to their serum ALT levels in the 2 years after hepatectomy: the low ALT group comprised 13 patients whose serum ALT levels showed a sustained low level below 80 IU, and the high ALT group comprised 21 patients whose serum ALT levels showed several peaks or plateaus above 80 IU. The patients had been followed-up prospectively with frequent ultrasonography and magnetic resonance imaging or computed tomography for recurrence for > 5 years. The survival period, non-recurrence interval and number of recurrences were observed. Recurrences were treated with transcatheter chemoembolization in all cases. The cumulative survival rate in the low ALT group was significantly better than that in the high ALT group (P < 0.05). The 5-year survival in the low ALT group was as high as 92.3% (12 of 13) compared with 33.3% (7 of 21) in the high ALT group (P < 0.05). The cumulative non-recurrence rate in the low ALT group was also significantly better than that in the high ALT group (P < 0.01). The survival period correlated well with the interval until the first recurrence (r = 0.545, P = 0.006). There was a tendency for the number of recurrences in the low ALT group (1.5 +/- 0.4, mean +/- SE) to be fewer than that in the high ALT group (2.2 +/- 0.4), although this was not significant. Sustained alleviation of inflammation, as indicated by low ALT levels, provides a survival advantage mainly due to the longer non-recurrence interval, and possibly because of fewer recurrences, in hepatectomized HCC patients with HCV-LC.
authors.affiliation: Department of Gastroenterology, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-ku, Yokohama 241-0815.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tarao
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Rino
authors.forename: Shoji
authors.initials: S
authors.lastname: Takemiya
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ohkawa
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sugimasa
authors.forename: Kaoru
authors.initials: K
authors.lastname: Miyakawa
authors.forename: Setsuo
authors.initials: S
authors.lastname: Tamai
authors.forename: Takahiro
authors.initials: T
authors.lastname: Masaki
authors.forename: Satoru
authors.initials: S
authors.lastname: Hirokawa
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Kameda
authors.forename: Tadashi
authors.initials: T
authors.lastname: Nagaoka
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Okamoto
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Kokubu
authors.forename: Muneki
authors.initials: M
authors.lastname: Yoshida
authors.forename: Akira
authors.initials: A
authors.lastname: Kakita
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000401:mortality / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D006526:Hepatitis C / Q000097:blood* / Q000401:mortality / Q000601:surgery; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000401:mortality / Q000601:surgery / Q000821:virology; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000401:mortality
chemical_list: D014408:Biomarkers, Tumor; D000410:Alanine Transaminase