A Liver Index and its Relationship to Indices of HCC Aggressiveness.

Brian I Carr,Maria Di Marco,Fabio Farinati,Edoardo G Giannini,Francesca Ciccarese,Gian Ludovico Rapaccini,Luisa Benvegnu,Vito Guerra

doi:10.4172/2329-6771.1000178

Abstract

A Hepatocellular (HCC) Aggressiveness Index was recently constructed, consisting of the sum of the scores for the 4 clinical parameters of maximum tumor size, multifocality, presence of portal vein thrombus and blood alphafetoprotein levels. It was observed that there was an association with several liver function tests. We have now formed a Liver Index from the 4 liver parameters with the highest hazard ratios with respect to HCC aggressiveness, namely: blood total bilirubin, gamma glutamyl transpeptidase (GGTP), albumin and platelet levels (cirrhosis surrogate). We found that the scores for the Liver Index related significantly to survival, but also to the Aggressiveness Index and to its individual HCC components as well as showing significant trends with the components. These results support the hypothesis that liver function is not only an important prognostic factor in HCC patients, but may also be involved in HCC biology and aggressiveness. Blood albumin, GGTP, albumin and platelet levels were used to create a Liver Index that related significantly to parameters of HCC aggressiveness.

Highlights

Human hepatocellular carcinoma (HCC) has 4 clinical characteristics that are used to evaluate treatment options and prognosis
Liver index and its relationship to patient survival The construction of the Liver Index is shown in Table 1, and comprises scores of 1, 2 or 3 which are assigned to the values in an HCC patient for blood levels of gamma glutamyl transpeptidase (GGTP), total bilirubin, albumin and platelet levels
It has been long accepted that the prognosis of HCC patients depends on both tumor extent or biology, as well as on liver disease severity [3] and these twin sets of influences have been incorporated into most modern staging systems [4,5,6]

Summary

Introduction

Human hepatocellular carcinoma (HCC) has 4 clinical characteristics that are used to evaluate treatment options and prognosis (in addition to metastasis). They are: maximum tumor diameter (MTD), presence or absence of of tumor multifocality, presence or absence of portal vein thrombus (PVT) and blood alphafetoprotein (AFP) level. These 4 parameters were recently integrated into an Aggressiveness Index, with points allotted to the level of each separate parameter and the total were summed [1]. We found that a composite Liver Score, comprising blood total bilirubin, GGTP, albumin and blood platelet levels (surrogate for cirrhosis) relate to both trends in the individual HCC aggressiveness components, and to the Aggressiveness Index

Methods

Results

Discussion