The Combination of Age, International Standardized Ratio, Albumin and γ-Glutamyl Transpeptidase (AIAG), Tumor Size and Alpha Fetoprotein (AFP) Stage as the Prognostic Model for Hepatitis B-Related Hepatocellular Carcinoma

Shuangchi Liu; Zhiduan Xu; Zhuling Fang; Dengyong Zhang; Zhongqiang Qin; Longfei Fan; Jiakang Duan; Hongxiang Yin; Yigang Zhang; Qing Pang; Yi Tan

doi:10.2147/IJGM.S323293

The Combination of Age, International Standardized Ratio, Albumin and γ-Glutamyl Transpeptidase (AIAG), Tumor Size and Alpha Fetoprotein (AFP) Stage as the Prognostic Model for Hepatitis B-Related Hepatocellular Carcinoma

Int J Gen Med. 2021 Aug 10:14:4291-4301. doi: 10.2147/IJGM.S323293. eCollection 2021.

Authors

Shuangchi Liu¹, Zhiduan Xu¹, Zhuling Fang², Dengyong Zhang¹, Zhongqiang Qin¹, Longfei Fan¹, Jiakang Duan¹, Hongxiang Yin¹, Yigang Zhang¹, Qing Pang^{1

3}, Yi Tan¹

Affiliations

¹ Department of Hepatobiliary Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, Anhui, People's Republic of China.
² Department of Medical Laboratory, Bengbu Medical College, Bengbu, Anhui, 233000, People's Republic of China.
³ Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China.

Abstract

Background: Advanced liver fibrosis can lead to cirrhosis, portal hypertension and liver failure. Besides, advanced liver fibrosis and cirrhosis are the major risk factors for hepatocellular carcinoma (HCC). Almost all patients with HCC also have liver cirrhosis. This study aims to predict the survival rate of hepatitis B-related hepatocellular carcinoma (HCC) by age, international standardized ratio, albumin and γ-glutamyl transpeptidase (AIAG), an indicator measuring the degree of cirrhosis.

Methods: A total of 501 hepatitis B-related HCC patients experiencing radical surgery were analyzed, retrospectively. General data about demographics and labs were collected at the date of diagnosis to calculate AIAG [age, international standardized ratio (INR), albumin and gamma-glutamyl transferase (GGT)]. The Kaplan-Meier curves and Cox analysis were used to evaluate overall survival (OS) and recurrence-free survival (RFS). The C-index was calculated in R software (version 4.0.3) to evaluate the accuracy of the prognostic model.

Results: During a median follow-up period of 30 months, 31.1% (156/501) of the patients died, and 34.3% (172/501) experienced the recurrence of HCC. Compared with patients with lower AIAG score, patients with higher AIAG score had higher Child-Pugh grade and were at higher Barcelona Clinic Liver Cancer (BCLC) stage (both P<0.05). Multivariate analysis suggested that GGT, alpha fetoprotein (AFP), tumor size, BCLC stage and AIAG grade were independent predictors of OS and RFS. Furthermore, the combined use of tumor size, AFP and AIAG stage could predict survival significantly better (C-index=0.710, 95% CI: 0.669-0.751) than BCLC stage.

Conclusion: AIAG is significantly associated with survival of HCC patients, and provides additional prognostic information for patients with HCC. Our findings suggest that the combination of AIAG, tumor size and AFP stage has a better predictive value for the prognosis of patients with hepatitis B-related hepatocellular carcinoma. However, it is necessary for more external evidences to determine clinical utility.

Keywords: AIAG; hepatocellular carcinoma; prognosis; survival.

Grants and funding

Science and Technological Fund of Anhui Province for Outstanding Youth (Grant No. 2008085J37), the First Affiliated Hospital of Bengbu Medical College Science Funding for Distinguished Young Scholars (Grant No. 2019byyfyjq05), the key project of Anhui Provincial Education Department (Grant No. KJ2018ZD022), the National Nature Science Foundation of China (Grant No. 81600452) and the project was supported by the Graduate Research Innovation Program of Bengbu Medical College(Grant No. Byycx20085). We thank for the supports from these funding sources.