Serum Liver Enzymes Serve as Prognostic Factors in Patients With Intrahepatic Cholangiocarcinoma

the ONA take:

Median survival for patients with intrahepatic cholangiocarcinoma (ICC), a rare gastrointestinal cancer being diagnosed in an increasing number of people, is poor: not more than 12 months. However, significant variations in survival status have been reported in the clinical data.

Liver function is often used as a prognostic factor for patients with many types of cancer, where clinical signs of liver damage are indicative of poor patient prognosis. In this study, researchers sought to determine the impact of these liver enzymes on overall survival for patients with ICC: albumin (ALB), globulin (GELO), total protein (TP), alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), direct bilirubin (DBIL), gamma glutamyltranspeptidase (GGT), and lactate dehydrogenase (LDH).

For the study, researchers enrolled patients with pathologically confirmed locally advanced or metastatic ICC between 2011 and 2015. The impact of levels of the 10 liver enzymes on overall survival was analyzed using Kaplan-Meier analysis. Then, univariate and multivariate analyses were used to evaluate the association between the liver enzymes and overall survival. Lastly, the researchers evaluated the role of these enzymes in overall survival in the subgroups.

Their findings reveal that elevated levels of ALP, TBIL, DBIL, and GGT were independent prognostic factors of poor outcome for patients with ICC, but elevated ALB is a protective factor for these patients. “Our results demonstrate that these liver enzymes may serve as valuable predictive markers in ICC patients,” the researchers conclude.

OncoTargets and Therapy
OncoTargets and Therapy

Objective: Liver functions, reflective of the overall status of the host, have been reported to be important factors affecting the prognosis in many types of cancers. In this study, we explored the influences of liver enzymes albumin (ALB), globulin (GELO), total protein (TP), alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), direct bilirubin (DBIL), gamma glutamyltranspeptidase (GGT), and lactate dehydrogenase (LDH) on the overall survival (OS) in a number of 173 patients with intrahepatic cholangiocarcinoma (ICC).
Patients and methods: Between 2011 and 2015, we enrolled patients with pathologically proven locally advanced or metastatic ICC. The impact of ALB, GELO, TP, ALP, ALT, AST, TBIL, DBIL, GGT, and LDH on OS were analyzed using Kaplan–Meier analysis. Next, the associations between these liver enzymes and OS were evaluated by univariate and multivariate analyses. Finally, the role of these enzymes in OS was evaluated in the subgroups.
Results: Elevated liver enzymes were linked with OS. We revealed that independent prognostic factors of poor outcome were ALP, TBIL, DBIL, and GGT, whereas ALB is a protective factor in ICC patients.
Conclusion: Our results demonstrate that these liver enzymes may serve as valuable predictive markers in ICC patients.


Keywords: liver enzymes, prognosis, overall survival, intrahepatic cholangiocarcinoma 

INTRODUCTION

Intrahepatic cholangiocarcinoma (ICC), as one of the most devastating malignancies, comprises 15% of all primary liver cancers.1,2 It is very sinister and signifies a dismal prognosis. Despite being a rare malignancy, studies have shown that a growing number of people are diagnosed with and dying of the disease.3–6 Unlike other tumors originating from the liver and gastrointestinal tract, the pathogenesis of ICC remains sophisticated and obscure, thus making the disease more intractable and challenging.7Moreover, the median survival of ICC patients is no more than 12 months, even after different treatments such as surgery, systemic chemotherapy, or radiotherapy.8 However, clinical data have shown that survival status varies significantly among patients with ICC. The commonly acknowledged factors that may serve as predictors for survival include intrahepatic satellite lesions, lymph node invasion, and distant metastasis.9–11

Cancer is a disease implicating the metabolism of the whole body rather than targeting organs.6 Liver functions, indicative of the degree of liver damage, partly reflect the tumor biology status. In clinical practice, we have found that patients with deteriorated liver functions often have unsatisfactory prognosis compared to those with tolerable parameters.

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