title: Impact of the branched-chain amino acid to tyrosine ratio and branched-chain amino acid granule therapy in patients with hepatocellular carcinoma: A propensity score analysis.
abstract: OBJECTIVE
  It has been reported that the branched-chain amino acid (BCAA) to tyrosine ratio (BTR) is a useful indicator of liver function and BCAA therapy is associated with a decreased incidence of hepatocellular carcinoma (HCC). However, there has not been sufficient research on the relationship between BTR and the effects of BCAA therapy after initial treatment of HCC. We investigated the impact of BTR and BCAA therapy on survival in patients with HCC.
  
  
  METHODS
  A total of 315 patients with HCC who were treated (n = 66) or not treated (n = 249) with BCAA were enrolled; of these, 66 were selected from each group using propensity score matching. Survival from liver-related mortality was analyzed.
  
  
  RESULTS
  In patients who did not receive BCAA therapy (n = 249), multivariate analysis for factors associated with survival indicated that low BTR (≤ 4.4) was independently associated with poor prognosis in patients with HCC (hazard ratio, 1.880; 95% confidence interval, 1.125-3.143; P = 0.016). In addition, among patients selected by propensity score matching (n = 132), multivariate analysis indicated that BCAA therapy was independently associated with good prognosis in patients with HCC (hazard ratio, 0.524; 95% confidence interval, 0.282-0.973; P = 0.041). BTR was not significantly associated with survival.
  
  
  CONCLUSIONS
  Intervention involving BCAA therapy improved survival in patients with HCC versus untreated controls, regardless of BTR. In addition, low BTR was associated with poor prognosis in patients who did not receive BCAA therapy.
authors: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan.
authors: Toshifumi
authors: T
authors: Tada
authors: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan.
authors: Takashi
authors: T
authors: Kumada
authors: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan.
authors: Hidenori
authors: H
authors: Toyoda
authors: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan.
authors: Seiki
authors: S
authors: Kiriyama
authors: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan.
authors: Makoto
authors: M
authors: Tanikawa
authors: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan.
authors: Yasuhiro
authors: Y
authors: Hisanaga
authors: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan.
authors: Akira
authors: A
authors: Kanamori
authors: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan.
authors: Shusuke
authors: S
authors: Kitabatake
authors: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan.
authors: Tsuyoki
authors: T
authors: Yama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000597:Amino Acids, Branched-Chain / Q000097:blood* / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D057216:Propensity Score; D015996:Survival Rate; D014443:Tyrosine / Q000097:blood*; D055815:Young Adult
chemical_list: D000597:Amino Acids, Branched-Chain; D014408:Biomarkers, Tumor; D014443:Tyrosine
keywords: branched-chain amino acid granules; branched-chain amino acid to tyrosine ratio; hepatocellular carcinoma; propensity score