title: Elevated perioperative transaminase level predicts intrahepatic recurrence in hepatitis B-related hepatocellular carcinoma after curative hepatectomy.
abstract: OBJECTIVE
  We aimed to evaluate the role of elevated perioperative alanine aminotransferase (ALT) as a surrogate marker of hepatitis activity in determining the risk of recurrence and survival in hepatitis B-related hepatocellular carcinoma (HCC) after curative hepatectomy.
  
  
  METHODS
  A retrospective review of the hepatectomy database was performed and 142 patients were found who had hepatitis B-related HCC from January 2001 to March 2006. Their ALT levels preoperatively and 1 month, 3 months, and 6 months postoperatively were recorded. The risk factors for recurrence and prognostic factors of survival were analysed.
  
  
  RESULTS
  An elevated perioperative ALT level (p = 0.021), multiple tumour nodules in the resected specimen (p < 0.001), and a tumour size greater than 5 cm (p = 0.001) were significant independent risk factors for tumour recurrence. The latter two factors were also independent prognostic factors for overall survival and disease-free survival. An elevated ALT level was an independent prognostic factor for disease-free survival (p = 0.025).
  
  
  CONCLUSIONS
  An elevated perioperative ALT level, which reflects increased hepatitis activity, is an independent risk factor for intrahepatic recurrence of hepatitis B-related HCC. It is also associated with a poorer disease-free survival rate.
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR.
authors.forename: Yue-Sun
authors.initials: YS
authors.lastname: Cheung
authors.forename: Henry L Y
authors.initials: HL
authors.lastname: Chan
authors.forename: John
authors.initials: J
authors.lastname: Wong
authors.forename: Kit-Fai
authors.initials: KF
authors.lastname: Lee
authors.forename: Terence C W
authors.initials: TC
authors.lastname: Poon
authors.forename: Nathalie
authors.initials: N
authors.lastname: Wong
authors.forename: Paul B S
authors.initials: PB
authors.lastname: Lai
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D005260:Female; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*
chemical_list: D014408:Biomarkers, Tumor; D000410:Alanine Transaminase