title: Elevated serum YKL-40 level predicts poor prognosis in hepatocellular carcinoma after surgery.
abstract: BACKGROUND
  YKL-40 is a member of the mammalian chitinase-like proteins. Elevated serum YKL-40 levels in patients with gastrointestinal cancer at time of diagnosis are associated with poor prognosis. The aim of this study is to evaluate the prognostic value of serum YKL-40 before surgery and during follow-up in hepatocellular carcinoma (HCC) patients receiving curative resection.
  
  
  METHODS
  Serum YKL-40 levels were determined by enzyme-linked immunosorbent assay. Overall and recurrence-free survival (RFS) curves were constructed using the Kaplan-Meier method and compared by the log-rank test. A Cox proportional-hazards regression model was performed to identify independent prognostic factors. Median follow-up time was 35 months.
  
  
  RESULTS
  Baseline serum YKL-40 was elevated in 56% of patients with HCC receiving curative resection. Patients with elevated serum YKL-40 had significantly shorter overall and RFS than patients with normal serum YKL-40 (P = 0.003 and P = 0.001, respectively). Multivariate Cox regression analyses indicated that baseline serum YKL-40 was an independent prognostic variable for overall and RFS [hazard ratio (HR) = 1.968, 95% confidence interval (CI): 1.093-3.543, P = 0.024; HR = 1.891, 95% CI: 1.106-3.232, P = 0.020; respectively]. After curative resection, high serum YKL-40 (log-transformed continuous variable) within 6 months predicted significantly poorer overall survival (HR = 3.003, 95% CI: 1.323-6.817, P = 0.009).
  
  
  CONCLUSIONS
  This study indicated that serum YKL-40 was an independent prognostic factor for overall and RFS in HCC patients receiving curative resection. Serial monitoring of serum YKL-40 after curative resection may provide prognostic information.
authors.affiliation: Department of Clinical Laboratory, Jinan Infectious Disease Hospital, Shandong University, Jinan, Shandong, People's Republic of China.
authors.forename: Cheng-Bao
authors.initials: CB
authors.lastname: Zhu
authors.forename: Li-Li
authors.initials: LL
authors.lastname: Chen
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Tian
authors.forename: Liang
authors.initials: L
authors.lastname: Su
authors.forename: Can
authors.initials: C
authors.lastname: Wang
authors.forename: Zhong-Tao
authors.initials: ZT
authors.lastname: Gai
authors.forename: Wen-Jun
authors.initials: WJ
authors.lastname: Du
authors.forename: Guo-Liang
authors.initials: GL
authors.lastname: Ma
mesh_terms: D054392:Adipokines / Q000097:blood*; D000293:Adolescent; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D000071451:Chitinase-3-Like Protein 1; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D037102:Lectins / Q000097:blood*; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult
chemical_list: D054392:Adipokines; D014408:Biomarkers, Tumor; C084533:CHI3L1 protein, human; D000071451:Chitinase-3-Like Protein 1; D037102:Lectins