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

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 

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.