Abstract
BackgroundPreoperative serum gamma-glutamyl transferase (γ-GT) levels is significantly related to the prognosis of hepatocellular carcinoma (HCC), but its clinical value in the management of postoperative adjuvant transarterial chemoembolization (PA-TACE) has rarely been explored. This study aimed to investigate whether γ-GT levels could be taken as a biomarker to guide the management of PA-TACE in resectable HCC.MethodsHCC patients receiving radical resection were identified through the primary liver cancer big data (PLCBD) from December 2012 to December 2015. Prognostic factors of overall survival (OS) and disease-free survival (DFS) were identified by univariate and multivariate cox analyses, and subgroup analysis was conducted between PA-TACE group and non-TACE stratified by γ-GT levels before and after 1:1 propensity score matching (PSM).Resultsγ-GT level was found to be an independent risk factor of OS and DFS in 1847 HCC patients receiving radical resection (both P < 0.05), and patients with elevated γ-GT(> 54.0 U/L) have a shortened median OS and DFS, compared with those with normal γ-GT (both P < 0.001). In the subgroup of patients with normal γ-GT, there were no significant differences between groups of PA-TACE and non-TACE in terms of median OS and DFS before and after PSM (all P > 0.05), and PA-TACE was not a significant prognostic factor of both OS and DFS before and after PSM (all P > 0.05). In the subgroup of patients with elevated γ-GT, significant differences were found between groups of PA-TACE and non-TACE in terms of median OS and DFS before and after PSM (all P < 0.05), and PA-TACE was an independent prognostic factor of both OS and DFS (all P < 0.05).ConclusionCurrently, we concluded that patients with more advanced HCC also have more elevated γ-GT, and these patients with elevated γ-GT would be benefited more from PA-TACE after radical resection.
Highlights
Currently, we concluded that patients with more advanced hepatocellular carcinoma (HCC) have more elevated gamma-glutamyl transferase (γ-GT), and these patients with elevated γ-GT would be benefited more from postoperative adjuvant transarterial chemoembolization (PA-TACE) after radical resection
Transarterial chemoembolization (TACE) is typically considered to be the first-line treatment for unresectable HCC according to the current guidelines [3, 4], but it has been tried prevalently to prevent the recurrence of patients receiving resection, especially in China [6,7,8]
Data of HCC patients receiving radical resection between December 2012 and December 2015 including age, sex, preoperative serum levels of alpha-fetoprotein (AFP), total bilirubin (TBil) and γ-GT level, tumor features confirmed by pathology, and follow-up was extracted from primary liver cancer big data (PLCBD) by an IT engineer, and was checked by three independent researchers
Summary
Preoperative serum gamma-glutamyl transferase (γ-GT) levels is significantly related to the prognosis of hepatocellular carcinoma (HCC), but its clinical value in the management of postoperative adjuvant transarterial chemoembolization (PA-TACE) has rarely been explored. A number of studies found that postoperative adjuvant TACE (PA-TACE) could decrease the incidence of early recurrence and improve the long-term prognosis [9, 10], but worries on its efficacy have never lessen: 1) PA-TACE was found not benefit for all patients receiving resection [11], 2) adverse events (AE) related to TACE was unavoidable [12], and 3) PA-TACE might potentially cause distant metastasis [13, 14]. Identifying the potential beneficiaries from PA-TACE is the key
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