title: Preoperative serum liver enzyme markers for predicting early recurrence after curative resection of hepatocellular carcinoma.
abstract: BACKGROUND
  Early recurrence of hepatocellular carcinoma (HCC) is associated with worse prognosis after liver resection. This study aimed to investigate the prognostic value of common liver enzyme markers in HCC early recurrence after curative hepatectomy and to establish a simple predictive model for HCC early recurrence.
  
  
  METHODS
  A total of 200 patients who had undergone curative resection for HCC were retrospectively analyzed. The patients were divided into early recurrence (within 2 years) and non-early recurrence groups. Demographical characteristics, preoperative liver function parameters, surgical factors and tumor related factors of the patients were assessed by univariate analysis to identify potential significant predictors for early recurrence after resection of HCC. Parameters with statistical significance were entered into a Cox proportional hazard model to find independent risk factors. Receiver operating characteristic analysis was done to determine optimal cut-off values and the number of combined factors in multi-factor predictive model.
  
  
  RESULTS
  Of 13 potential risk factors for early recurrence identified by univariate analysis, high lactate dehydrogenase (LDH>206 U/L, HR=1.711, P=0.006), high aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AST/ALT>0.96, HR=1.769, P=0.006), elevated alpha-fetoprotein (AFP<8.6 ng/mL, HR=2.079, P=0.007), small resection margin (≤1 cm, HR=2.354, P<0.001) and advanced TNM stage (TNM III-IV, HR=2.164, P<0.001) were independent risk factors for early recurrence of HCC shown by multivariate analysis. Patients with three or more concurrent independent risk factors had significantly higher risk for early recurrence than those with low risk factors. The sensitivity and specificity of this predictive model are 53.6% and 80.7%, respectively (area under curve=0.741, 95% CI 0.674-0.800, P<0.0001).
  
  
  CONCLUSIONS
  Preoperative common liver enzyme markers, LDH and AST/ALT ratio, were independently associated with early recurrence of HCC. The combination of serum liver enzyme markers with AFP, resection margin and TNM stage better predicted early recurrence of HCC after curative resection in a simple multi-factor model.
authors: Department of Hepatobiliary Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China. yitaoding1950@gmail.com.
authors: Zhong-Xia
authors: ZX
authors: Wang
authors: Chun-Ping
authors: CP
authors: Jiang
authors: Yin
authors: Y
authors: Cao
authors: Guang
authors: G
authors: Zhang
authors: Wei-Bo
authors: WB
authors: Chen
authors: Yi-Tao
authors: YT
authors: Ding
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000556:secondary / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D006801:Humans; D006836:Hydro-Lyases / Q000097:blood*; D008113:Liver Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D057234:Preoperative Period; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D006836:Hydro-Lyases; C045581:lactate dehydratase