İnoperable Hepatosellüler karsinom’da lokorejyonel tedavi yanıtını öngörmek için albümin ve CRP ilişkili immüno-nutrisyon belirteçlerin kullanımı

Abstract

Amaç: Controlling nutritional status (Conut) skor, lenfosit-albümin faktörü (LA), Albümin-bilirubin skor (ALBİ), high sensitif modifiye Glasgow prognostik skor (Hs-mGPS), Glasgow prognostik skoru (GPS) gibi albümin ve C-reaktive protein (CRP) ilişkili inflamasyon belirteçleri ile HCC’de lokorejyonel tedavi yanıtı arasındaki ilişkiyi inceledik. Gereç ve yöntem: Yüz seksen HCC hastasından lokorejyonel tedavi uygulanan 63 hasta bu çalışmaya dahil edildi. Tedavi sonrası dördüncü-sekizinci hafta aralığındaki rutin laboratuvar testleri kaydedilerek albümin ve CRP ilişkili immüno-nutrisyon skorları hesaplandı. Literatürde yer alan cut-off değerleri kullanıldı. Bu belirteçlerin genel sağkalım (OS) ve tedavi sonrası hastalıksız sağkalım (DFS) için prediktif ve prognostik değeri analiz edildi. Bulgular: Yaş ortalaması 63 (min-max:26-87) olan hastaların 59’u (%93,7) erkekti. Ortalama takip süresi 25 ay olup 53 hasta merhumdu (%84,1). Median genel sağkalım (mOS):18,56 ay (min-max:13,13-23,99); lokorejyonel tedavi sonrası mDFS:7ay (min-max:3,63-10,37) olarak belirlendi. Yaş (p=0,019), Conut (p=0,001), GPS (p=0,028), Hs-mGPS (p=0,012), LA (p=0,017) ve ALBI (p=0,002) ile mOS arasında istatistiksel anlamlı ilişki bulundu. Conut (p=0,002), GPS (p<0,001), Hs-mGPS (p=0,002), LA (p=0,002) ve ALBI (p=0,001) ile median hastalıksız sağkalım (mDFS) arasındaki ilişki istatistiksel olarak anlamlı bulundu. Multivariate analiz sonucunda; ≥65 yaş olanların (HR:2,10; %95 CI:1,02-4,30; p=0,042) ve hiç sistemik tedavi almayanların (HR:4,11; %95 CI:1,35-12,56; p=0,013) ölüm riskinin arttığı belirlendi (p<0,001). Bir diğer anlamlı sonuç ise GPS’nin ‘2’ olmasının (HR:6,62; %95 CI:1,13-38,62; p=0,036) yüksek progresyon riskini öngördüğü idi (p<0,001). Sonuç: Lokorejyonel tedavi uygulanan HCC’li hastalarda; yaş, Conut skor, GPS, HsmGPS, LA ve ALBI skorun, hastaların mOS ve mDFS için önemli prediktif faktörler olduğunu saptadık. Tüm bu sonuçlar oluşturduğumuz prognostik modellemenin klinik pratikte kullanımının yararlı olabileceğini düşündürmektedir.

Keywords

• HCC
• TACE
• Conut skor
• GPS
• HsmGPS

Use of albumin and CRP related immuno-nutritional markers for prediction of locoregional response to treatment in unresectable hepatocellular carcinoma

Abstract

Purpose: We examined the relationship between albumin and C reactive protein (CRP)-related inflammation markers such as Controlling nutritional status (Conut) score, lymphocyte-albumin factor (LA), albumin-bilirubin score (ALBI), highly sensitive modified Glasgow prognostic score (Hs-mGPS), Glasgow prognostic score (GPS) and locoregional treatment response in HCC. Materials and methods: One hundred and eighty HCC patients and 63 patients who underwent locoregional therapy were included in this study. Routine laboratory tests between the fourth and eighth week after treatment were recorded and albumin and CRP-related immuno-nutrition scores were calculated. Cut-off values from the literature were used. The predictive and prognostic value of these markers for overall survival (OS) and diseasefree survival (DFS) after treatment were analyzed. Results: The mean age was 63 years (min-max:26-87) and 59 (93.7%) of the patients were male. The mean follow-up period was 25 months and 53 patients were deceased (84.1%). Median overall survival (mOS):18.56 months (min-max:13.13-23.99); median disease-free survival (mDFS):7 months (min-max:3.63-10.37) after locoregional treatment. Age (p=0.019), Conut (p=0.001), GPS (p=0.028), Hs-mGPS (p=0.012), LA (p=0.017) and ALBI (p=0.002) were significantly correlated with mOS. Conut (p=0.002), GPS (p<0.001), Hs-mGPS (p=0.002), LA (p=0.002) and ALBI (p=0.001) were significantly correlated with mDFS. Multivariate analysis revealed that those aged ≥65 years (HR:2.10; 95% CI:1.02-4.30; p=0.042) and those who received no systemic therapy (HR:4.11; 95% CI:1.35-12.56; p=0.013) had an increased risk of death (p<0.001). Another significant result was that a GPS of '2' (HR:6.62; 95% CI:1.13-38.62; p=0.036) predicted a higher risk of progression (p<0.001). Conclusion: In this study, we found that age, Conut score, GPS, HsmGPS, LA and ALBI score significantly predicted mOS and mDFS in locoregionally treated HCC patients. All these results suggest that our prognostic modelling may be useful in clinical practice.

Keywords

• HCC
• TACE
• Conut score
• GPS
• HsmGPS

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