title: Clinical and prognostic significance of urinary trypsin inhibitor in patients with hepatocellular carcinoma after hepatectomy.
abstract: BACKGROUND
  Urinary trypsin inhibitor (UTI), produced in the liver, has been considered to suppress inflammation. The production of UTI may decrease after a hepatectomy and thereby increase the incidence of postoperative inflammation. This study investigated whether the changes in the UTI level affected the postoperative course in patients undergoing a hepatectomy for hepatocellular carcinoma (HCC). The prognostic significance of UTI was also analyzed.
  
  
  METHODS
  The perioperative plasma UTI was measured in 25 HCC patients who underwent hepatic resection, and the correlation between the kinetics of UTI and clinicopathological factors was investigated. The expression of UTI in the resected specimens was examined by immunohistochemistry in 65 patients. Expression of UTI in the cancer cells were then correlated to both the liver pathology and the clinical outcomes in the corresponding patients.
  
  
  RESULTS
  The plasma UTI level greatly decreased on the first postoperative day. This decrease significantly correlated with the resected tumor volume (r (s) = -.530, P = .006), but it had no influence on inflammatory complications. Immunohistochemistry revealed UTI expression in both noncancerous and cancerous lesions. An overexpression of UTI in HCC tissue was found to be an independent prognostic factor for early recurrence (P = .006).
  
  
  CONCLUSIONS
  Although UTI plasma levels were noted to decrease after the removal of an HCC tumor, this decrease did not lead to an increase in inflammatory complications. However, overexpression of UTI in cancer was found to be a risk factor for tumor recurrence after resection, suggesting that UTI expression may be a useful prognostic marker.
authors.affiliation: Department of Gastroenterological Surgery, Akita University School of Medicine, Akita, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Kikuchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Uchinami
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nanjo
authors.forename: Manabu
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Akio
authors.initials: A
authors.lastname: Nakajima
authors.forename: Makoto
authors.initials: M
authors.lastname: Kume
authors.forename: Ali
authors.initials: A
authors.lastname: Mencin
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Yamamoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D015153:Blotting, Western; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006023:Glycoproteins / Q000097:blood* / Q000235:genetics; D006498:Hepatectomy; D006801:Humans; D007124:Immunoenzyme Techniques; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000378:metabolism; D009367:Neoplasm Staging; D011379:Prognosis; D012333:RNA, Messenger / Q000235:genetics / Q000378:metabolism; D012372:ROC Curve; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D014408:Biomarkers, Tumor; D006023:Glycoproteins; D012333:RNA, Messenger; C028665:urinastatin