title: A high value of serum des-γ-carboxy prothrombin before hepatocellular carcinoma treatment can be associated with long-term liver dysfunction after treatment.
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.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Saito
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Seo
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Yano
authors.forename: Akira
authors.initials: A
authors.lastname: Miki
authors.forename: Masaru
authors.initials: M
authors.lastname: Yoshida
authors.forename: Takeshi
authors.initials: T
authors.lastname: Azuma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000150:complications / Q000628:therapy; D016022:Case-Control Studies; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D008113:Liver Neoplasms / Q000097:blood* / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D011516:Prothrombin; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D011498:Protein Precursors; C008208:acarboxyprothrombin; D011516:Prothrombin