| Objective:Hepatocellular carcinoma(HCC)has a high incidence and mortality that are causing a huge impact on human health.In clinical cases,most patients are in the medium and advanced stages of threatment.The survival of patients with HCC after resection remains poor due to the recurrence and metastasis.Therefore,more preoperative tumor biomarkers that can better predict HCC relapse and metastasis are urgently needed.For this porpose,we analyzed the peripheral blood biomedical parameters in patients with HCC in order to investigate the prognostic value of preoperative alkaline phosphatase to albumin ratio(APAR)and aspartate aminotransferase to albumin ratio(AAR)in patients with hepatocellular carcinoma(HCC)undergoing curative hepatectomy.Materials and Methods:Clinical pathological data of 330 HCC patients who underwent radical resection from November 2010 to January 2014 were retrospectively analyzed.Receiver operating characteristic(ROC)curves of APAR and AAR for diagnostic tumor recurrence were plotted and the two cut-off values were defined.The whole enrolled patients were divided into the high-APAR group(APAR>1.74),high-AAR group(AAR≥1.00),low-APAR group(APAR<1.74)and low-AAR group(AAR<1.00).Correlations between APAR level,AAR level and clinicopathological features were assessed using x2 test.The survival analysis was performed using Kaplan-Meier method and Log-rank test.Independent risk factor analysis was conducted by COX proportional-hazards regression model.Results:The cut-off values of APAR and AAR for predicting survival after operation were 1.74 and 1.00,respectively.The correlation analysis demonstrated that the preoperative high APAR level was significantly associated with HBsAg,tumor diameter,TNM stage(P<0.05).In addition,the preoperative high AAR level was also determined to be closely correlated with liver cirrhosis by correlation analysis(P<0.05).Moreover,the Kaplan-meier analysis confirmed that the relapse-free survival(RFS)and overall survival(OS)of patients with high preoperative APAR and AAR level were shorter than those with low preoperative APAR and AAR(P<0.05).The independent risk factors for RFS were the preoperative APAR ≥ 1.74,preoperative AAR ≥ 1.00 and macrovascular invasion or tumor thrombus.The independent risk factors for OS were the preoperative APAR>1.74,preoperative AAR≥ 1.00,clinical symptoms,AFP>20ng/ml,macrovascular invasion or tumor thrombus and family history of cancer.Conclusion:Preoperative APAR and AAR level were two independent risk factors for influencing the prognosis of patients with hepatocellular carcinoma after hepatectomy.The HCC patients with preoperative APAR ≥ 1.74 and/or AAR ≥ 1.00 have poor prognosis after operation.Objective:To establish a new scoring system based on the clinicopathological features of Hepatocellular carcinoma(HCC)to predict prognosis of patients underwent hepatectomy.Methods:A total of 845 patients with HCC undergone surgery were retrospectively analyzed from 1999 to 2010 at Cancer Hospital,Chinese Academy of Medical Science.21 common clinical factors were selected to perform the analysis.Among these factors,the cut-off values of alpha-fetoprotein(AFP),alkaline phosphatase(ALP)and intraoperative blood loss were performed by using a receiver operating characteristic(ROC)curve analysis.The Kaplan-meier method and COX regression analysis were used to evaluate the risk factors associated with prognosis.With weighted sum method applied in the independent risk factors,scoring system was established after hepatectomy.Then according to the scoring system,the patients were divided into 3 risk groups(low-risk,intermediate-risk and high-risk),the relapse-free survival(RFS)and overall survival(OS)were compared among these groups.Results:The univariate analysis showed that factors,including clinical symptoms,preoperative AFP level,serum ALP level,tumor size,tumor number,abdominal lymph node metastasis,macrovascular invasion or tumor thrombus,extrahepatic invasion or serosa perforation,the severity of hepatic cirrhosis,intraoperative blood loss,the liver surgery method,pathological tumors thrombus,intraoperative blood transfusion,perioperative blood transfusion,were associated with median RFS of these HCC patients(P<0.05);The factors,including clinical symptoms,preoperative AFP level,serum ALP level,tumor size,tumor number,abdominal lymph node metastasis,macrovascular invasion or tumor thrombus,extrahepatic invasion or serosa perforation,the severity of hepatic cirrhosis,intraoperative blood loss,the liver surgery method,pathological lymphocytes invasion,pathological tumors thrombus,intraoperative blood transfusion,perioperative blood transfusion,were associated with the median OS of these HCC patients(P<0.05).The multivariate analysis showed that the independent risk factors of RFS and OS were AFP≥20ng/ml,clinical symptoms,tumor diameter≥5cm,multiple tumors,macrovascular invasion or tumor thrombus,extrahepatic invasion or serosa perforation,moderate and severe liver cirrhosis,non anatomic resection;The independent risk factor of RFS was intraoperative bleeding loss>325ml;The independent risk factors of OS were abdominal lymph node metastasis and pathological tumors thrombus.We use these 11 independent factors to establish the scoring system through their respective weight and scores range from 0 to 30.1n the sore system,0 to 5 points were defined as the low-risk group(286 cases),6 to 12 points were determined as the intermediate-risk group(503 cases),more than 13 points were classified as the high-risk group(56 cases).The median RFS of the low-risk,intermediate and high-risk groups were 80,27 and 6 months,respectively.The difference was statistically significant(P<0.001).The median OS of three groups was 134,51 and 15 months,respectively,and the difference was statistically significant(P<0.001).Conclusion:This new score system provides good prognostic accuracy for HCC patients after hepatectomy.Objective:To investigate the expression of Yes-associated protein(YAP)and its relationship with proliferation,clinicopathological characteristics and prognosis in Hepatocellular carcinoma(HCC).Materials and Methods:A total of 98 paraffin specimens obtainted from HCC patients with detailed clinicopathological factors and follow-up data were retrospectively analyzed.The expression of YAP in pathological sections was detected by immunohistochemical staining.Clinicopathological and prognostic significance of Yes-associated protein expression in HCC were evaluated.After that,RNA interfere was performed to explore YAP functions in proliferation of hepatocellular carcinoma.The YAP mRNAand protein expression were examined by Real time PCR and Western,respectively.Results:The positive expression rate of YAP in HCC was 21.4%(21/98),the negative expression rate of YAP was 77.7%(77/99)and the high expression rate of YAP was 10.2%(10/98).The univariate analysis showed that preoperative alpha-fetal protein(AFP)level,macrovascular invasion or tumor thrombus and YAP expression were correlated with the median relapse-free survival(RFS)and overall survival(OS)of these HCC patients(^<0.05).The multivariate analysis showed that the independent risk factors of RFS and OS were AFP ≥ 20ng/ml,macrovascular invasion/tumor thrombus and YAP positive expression.Kaplan-Meier survival analysis showed that the patients with positive expression of YAP had shorter RFS and OS than those with negative YAP expression(P<0.05).In addition,the cell proliferation of MHCC-97H became slowly after YAP gene silencing.Conclusion:YAP was relevant to HCC proliferation and prognosis.YAP could be a novel valuable molecular marker to predict the post operation prognosis of HCC. |
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