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Liver damage parameters and prognosis in patients with hepatocellular carcinoma

Brian I Carr, Harika Gozukara Bag, Hikmet Akkiz, �?�??�?�???mit Karao�?�??�?�???ullar�?�??�?�??�?�??�?�?�?±ndan, Volkan Ince, Burak Isik, Sezai Yilmaz

Background: Patients with small HCCs typically have low AFP levels and there is a need for other biomarkers in this setting. Objectives: To assess the usefulness of liver inflammation parameters in prognosis. Methods: A retrospective study of prospectively collected data on 265 non-surgical HCC patients was analyzed, using Kaplan-Meier and Cox regression analysis. Results: Patient survival was significantly different in subgroups after dichotomization according to serum levels of AST, GGT, albumin or ALKP, whether they had small (<5cm) or large (>5cm) HCCs. The main difference between patients with better or worse survival was the serum bilirubin level. Tumor aggressiveness parameter differences (PVT, AFP, multifocality) were also found, predominantly in patients with larger tumors. The survival differences after inflammation parameter dichotomization were mainly found in patients with low AFP levels. Conclusions: Serum inflammation parameter levels were associated with differences in survival for patients with large or small tumors, but mainly in the absence of high serum AFP levels. Patients with smaller tumors may die of liver damage, but those with larger tumors likely die of both liver and tumor factors. These inflammation parameters may thus be useful in patients with low AFP levels, for whom there are few useful serum biomarkers.