Sezgin VATANSEVER, Fatih Esat TOPAL, Suleyman GÜNAY, Firdevs TOPAL, Ünal TAŞDEMİR, Zeynep Zehra GÜMÜŞ, Sabiye AKBULUT, Elif SARITAŞ YÜKSEK

P2/MS ve AFP'nin Hepatoselüler Kanser Nüksünü Öngördürmedeki Yeri

Amaç: P2/MS sirozdaki karaciğer fibrozunu değerlendirmek kullanılan basit, pahalı olmayan, non-invaziv bir testtir. Hepatoselüler karsinomda artmış alfa-fetoprotein düzeyleri ise rekürrens ile ilişkilidir. Bu çalışmada hepatoselüler karsinom nüksünün erken öngörümünde P2/MS ve alfa-fetoprotein etkinliğini değerlendirmeyi ve bir cutoff değeri araştırmayı amaçladık. Gereç ve Yöntem: Hepatoselüler karsinoması olan 69 hasta retrospektif olarak rekürrens varlığı açısından tarandı. Hastalardaki rekürrens varlığı radyolojik olarak trifazik bilgisayarlı tomografi ve magnetik rezonans inceleme ile değerlendirildi. P2/MS formülü olarak trombosit sayısı (109 /L)2 /[monosit yüzdesi (%) x nötrofil yüzdesi (%)]. Bulgular: Toplam 42 hastada hepatoselüler karsinom rekürrensi belirlendi. Rekürrens öngörümü açısından P2/MS cut-off değeri ≤59.9 alındığında %100 spesifite ve %95.24 sensiviteye sahip olduğu bulundu. Alfa-fetoprotein için cut-off değeri >57.5 alındığındaysa sensivitesi %83.3 ve spesifitesi %92.6 saptandı. Sonuç: Bu bulgular ışığında P2/MS ve alfa-fetoproteinin hepatoselüler karsinom rekürrensini öngördürmede güvenilir belirteçler gibi değerlendirilebilmektedir. Bu iki non-invaziv yöntemin hepatoselüler rekürrensinin erken tahmininde kullanılması gerektiğini önermekteyiz

Efficacy of P2/MS and AFP in Early Prediction of Hepatocellular Carcinoma Recurrence

Objective: P2/MS is a simple, inexpensive and non-invasive test for the evaluation ofhepatic fibrosis in cirrhosis. Elevated alpha-fetoprotein levels in hepatocellularcarcinoma is related with recurrence. We aimed to examine the efficacy of P2/MS andalpha-fetoproteinin early prediction of hepatocellular carcinoma recurrence and todetermine a cut-off value for P2/MS and alpha-fetoprotein.Methods: Sixty nine patients with hepatocellular carcinoma were retrospectivelyscanned for recurrence existence. The recurrence of hepatocellular carcinoma wasdiagnosed radiologically, via 3-phase tomography and magnetic resonanceinvestigation. The formula of P2/MS was platelet count (109/L)2/[monocyte count(%)x neutrophil count(%)].Results: Forty two patients had hepatocellular carcinoma recurrence. For therecurrence prediction, the cut-off value of P2/MS was ≤59.9 with 100% specificityand 95.24% sensitivity. The cut-off value of alpha-fetoprotein was found >57.5 with83.3% sensitivity and 92.6% specificity.Conclusions: With these findings, P2/MS and alpha-fetoprotein seems as reliablemarkers for the prediction of hepatocellular carcinoma recurrence. We suggest thatthey can be used as non-invasive tools for the early estimation of hepatocellularcarcinoma recurrence

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1. Balogh J, Victor D 3rd, Asham EH, et al. Hepatocellular carcinoma: a review. Journalofhepatocellularcarcinoma2016;3:41–53. doi:10.2147/JHC.S61146
2. Global Burden of Disease Liver Cancer Collaboration, AkinyemijuT, Abera S, Ahmed M, et al. The Burden of Primary Liver Cancer and Underlying Etiologies From 1990 to 2015 at the Global, Regional, and National Level: Results From the Global Burden of Disease Study 2015. JAMAoncology2017;3(12):1683- 1691. doi:10.1001/jamaoncol.2017.3055
3. Mughal TI, Patel SB. Hepatocellular carcinoma: A review of 140 cases. AnnSaudiMed1996;16(1):53-5.
4. Prates MD, Torres FO. A cancer survey in Lourenço Marques, Portuguese East Africa. JNatlCancerInst1965;35(5):729-57.
5. The Cancer of the Liver Italian Program (CLIP) investigators. A new prognostic system for hepatocellular carcinoma a retrospective study of 435 patients. Hepatology1998;28(3):751.
6. El-Serag HB., Marrero JA, Rudolph L, Reddy KR. Diagnosis and treatment of hepatocellular carcinoma. Gastroenterology2008;134:1752-63.
7. Castán A, Navarro Y, Sarría L, Larrosa R, Serradilla M, Serrablo A. Radiological diagnosis of hepatocellular carcinoma in non-cirrhotic patients. HepatomaRes2017;3:1-17. https://doi.org/10.20517/2394-5079.2015.62
8. Schwartz JM, Carithers RLJr. Epidemiology and etiologic associations of hepatocellular carcinoma. Available at https://www.uptodate.com/contents/epidemiology-and-etiologic-associations-ofhepatocellular-carcinoma
9. Matsumura H, Moriyama M, Goto I, Tanaka N, Okubo H, Arakawa Y. Natural course of progression of liver fibrosis in Japanese patients with chronic liver disease type C--a study of 527 patients at one establishment. JViralHepat2000;7(4):268-75.
10. Pawlik TM, Poon RT, AbdallaEK, et al. Critical appraisal of the clinical and pathologic predictors of survival after resection of large hepatocellular carcinoma. ArchSurg2005;140(5):450-458.
11. Spinzi G, Terruzzi V, Minoli G. Liver biopsy. N Engl J Med2001;344:2030.
12. Ziol M, Handra-Luca A, Kettaneh A, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology2008;41:48-54.
13. Friedrich-Rust M, Ong MF, Martens S, et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology2008;134:960-974.
14. Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology2006;43:1317-1325.
15. Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology2003;38:518-526.
16. Sheth SG,Flamm SL, Gordon FD, Chopra S. AST/ALT ratio predicts cirrhosis in patients with chronic hepatitis C virus infection. AmJGastroenterol1998;93:44-48.
17. Poynard T, Bedossa P. Age and platelet count: a simple index for predicting the presence of histological lesions patients with antibodies to hepatitis C virus. METAVIR and CLINIVIR Cooperative Study Groups. JViralHepat1997;4:199-208.
18. Manka P, Zeller A, Syn WK. Fibrosis in Chronic Liver Disease: An Update on Diagnostic and Treatment Modalities. Drugs2019;79(9):903-927. doi: 10.1007/s40265-019-01126-9.
19. Lee JH, Yoon JH, Lee CH, et al. Complete blood count reflects the degree of oesophageal varices and liver fibrosis in virus-related chronic liver disease patients. JViralHepat2009;16:444-452.
20. Kim BK, Han KH, Park JY, et al. External validation of P2/MS and comparison with other simple noninvasive indices for predicting liver fibrosis in HBV-infected patients. DigDisSci2010;55:2636-2643.
21. Kim BK, Han KH, Park JY,et al. Prospective validation of P2/MS noninvasive index using complete blood counts for detecting oesophageal varices in B-viral cirrhosis. LiverInt2010;30:860-866.
22. Mehta N, Heimbach J, Harnois DM, et al. Validation of a Risk Estimation of Tumor Recurrence After Transplant (RETREAT) Score for Hepatocellular Carcinoma Recurrence After Liver Transplant. JAMAOncol2017;3(4):493.
23. O'Rourke JM, Sagar VM, Shah T,Shetty S. Carcinogenesis on the background of liver fibrosis: Implications for the management of hepatocellular cancer. Worldjournalofgastroenterology2018;24(39):4436– 4447.doi:10.3748/wjg.v24.i39.4436
24. Lin CS, Chang CS, Yang SS, Yeh HZ, Lin CW. Retrospective evaluation of serum markers APRI and AST/ALT for assessing liver fibrosis and cirrhosis in chronic hepatitis B and C patients with hepatocellular carcinoma. Intern Med2008;47:569-575.

ISSN: 1309-3878
Yayın Aralığı: 3
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez