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CRP is a superior and prognostically significant inflammation biomarker for hepatocellular cancer patients treated by liver transplantation.

Brian I Carr, Volkan Ince, Harika Gozukara Bag, Sertac Usta, Veysel Ersan, Burak Isik and Sezai Yilmaz

Background: Inflammation and its markers are considered prognostically important for many cancers, including hepatocellular carcinoma (HCC). However, it is not really clear which are the best. Aims: To assess in a cohort of prospectively-evaluated HCC patients who were treated with liver transplant and whose survival was known, multiple commonly used inflammatory markers in relation to survival and to both clinical and tumor aggressiveness parameters. Results: Amongst 330 transplanted HCC patients, CRP was found to be the only significant inflammatory marker for survival, on multivariate Cox regression analysis. NLR, PLR, GGT, AST, ALT and the Glasgow inflammation score were also found to be significant, but on univariate analysis only. CRP was significant in patients with both small (<5cm) and large HCCs and in patients with elevated or low alpha-fetoprotein (AFP) levels. Comparison of HCC patients with high (>2.5mg/dL) compared low serum CRP levels showed significant differences for blood levels of NLR, LMR, Hb, total bilirubin and liver transaminases, as well as maximum tumor diameter (MTD) and percent of patients with portal vein thrombosis (PVT). Conclusions: Elevated serum CRP levels were associated with significantly increased MTD and percent of patients with PVT and significantly worse overall survival in HCC patients who were treated by liver transplantation.