AFP düzeyi normal olan hepatoselüler karsinomalı hastalarda mikrovasküler invazyon ve kötü diferansiyasyonu tahmin eden parametreler
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2021
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İnönü Üniversitesi
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Abstract
Amaç: Hepatoselüler karsinomalı (HSK) hastalarda, karaciğer nakli (KN) öncesine ait, tam kan sayımı ve rutin biyokimyasal verileri kullanarak, eksplant patoloji sonucuna göre mikrovasküler invazyon (MİVİ) varlığını ve tümörün kötü diferasiyasyon derecesini tahmin edebilecek, basit, ucuz, tekrar edilebilir parametreleri araştırmaktır. Gereç ve Yöntem: Mart 2006 ile Kasım 2021 tarihleri arasında İnönü Üniversitesi Karaciğer Nakli Enstitüsü'nde, HSK tanısı ile KN yapılmış olan hastaların verileri, geriye dönük olarak tarandı. Hastaların demografik verileri, KN öncesinde alınan kan numunelerinden çalışılan, rutin hematolojik ve biyokimyasal parametrelerin sonuçları, eksplant patoloji raporlarındaki tümör özellikleri (maksimum tümör boyutu, tümör sayısı, diferansiyasyon derecesi ve MİVİ durumu) ve KN sonrası rekürrens oranı kaydedildi. Değişkenlerin kötü diferansiyasyon ve MİVİ üzerine olan etkileri tek değişkenli ve çoklu değişkenli model ile analiz edildi. Bulgular: Serum Alfa-Fetoprotein (AFP) düzeyi normal olan hastalarda MİVİ pozitifliği %28,6, kötü diferansiyasyon oranı %9,3, karaciğer nakli sonrası HSK rekürrens oranı %12,1 (n=17) ve medyan rekürrens süresi 13 ay (1 – 40,1 ay) olarak bulundu. Çok değişkenli analiz sonucunda, KN öncesi AFP düzeyi normal olanlarda, MİVİ pozitifliğinin bağımsız risk faktörleri, Maksimum Tümör Boyutu(MTB)>4,5cm ve tümör sayısı>5 olması iken; kötü diferansiyasyon için bağımsız risk faktörleri, tümör sayısı>4 ve Mean Platelet Volume? 8,6 olarak bulundu. Karaciğer nakli sonrası Hepatoselüler Karsinom rekürrensi gelişenlerin %53'ünde, serum AFP düzeyi, rekürrens tanı anında, halen normal olarak bulunmuştur. Sonuçlar: KN öncesi AFP düzeyi normal olan HSK'li hastalarda, MTB ve tümör sayısı MİVİ için bağımsız risk faktörü iken, tümör sayısı ve MPV kötü diferansiyasyon için bağımsız risk faktörü olarak bulunmuştur. Ayrıca, KN öncesi AFP düzeyi normal olan hastaların %53'ünde rekürrens anında dahi AFP düzeyleri normal olarak saptanmışken, %47'sinde AFP düzeyleri artmıştır.
Aim: The aim of this study is; to evaluate the parameters which might be associated with the pathologically diagnosed microvascular invasion (MİVİ) and poor differentiation, using complete blood count and routine clinical biochemistry tests results, in hepatocellular carcinoma (HCC) patients before liver transplantation. Materials and Methods: The data of the patients who underwent liver transplantation for HCC at Inonu University Liver Transplant Institue, between March 2006 and November 2021 was researched retrospectively. Demographic information of the patients, results of routine hematological and biochemical tests performed before transplantation, the recurrence rate after transplantation, pathological characteristics of primary tumor(maximum tumor diameter, number of nodules, degree of differentiation, presence of microvascular invasion) were recorded. The effects of these variables on the presence of microvascular invasion presence or poor differentiation were statistically analyzed by using univariate and multivariate analyses methods. Findingds: Incidence of microvascular invasion or poor differentiation rate, recurrences after liver transplantation and median recurrence rate, in patients with normal AFP level, were 28.6%, 9.3%, 12.1%, 13 months respectively. After univariate, and multivariate analyzes, Maximum Tumor Diamater (MTD)>4.5cm and number of nodule>5 were found to be independent risk factors for MIVI, and number of nodule>4 and Mean Platelet Volume (MPV)?8.6 fL were found to be independent risk factors for poor differentiation. The serum AFP levels were still normal at the recurrence time, in the 53% of the patients who had recurrence after liver transplantation, but were elevated in 47% of the recurrence patients. Conclusions: In HCC patients whose AFP level is normal before liver transplantation, independent risk factors of the presence of MİVİ, were, MTD and number of nodules, and independent risk factors of poor differentiation, were, MPV and number of nodules. Furthermore, serum AFP levels of 53% of the HCC patients whose AFP levels were normal before liver transplantation, were normal even at the recurrence time, but serum AFP levels were elevated 47% of the patients at recurrence time.
Aim: The aim of this study is; to evaluate the parameters which might be associated with the pathologically diagnosed microvascular invasion (MİVİ) and poor differentiation, using complete blood count and routine clinical biochemistry tests results, in hepatocellular carcinoma (HCC) patients before liver transplantation. Materials and Methods: The data of the patients who underwent liver transplantation for HCC at Inonu University Liver Transplant Institue, between March 2006 and November 2021 was researched retrospectively. Demographic information of the patients, results of routine hematological and biochemical tests performed before transplantation, the recurrence rate after transplantation, pathological characteristics of primary tumor(maximum tumor diameter, number of nodules, degree of differentiation, presence of microvascular invasion) were recorded. The effects of these variables on the presence of microvascular invasion presence or poor differentiation were statistically analyzed by using univariate and multivariate analyses methods. Findingds: Incidence of microvascular invasion or poor differentiation rate, recurrences after liver transplantation and median recurrence rate, in patients with normal AFP level, were 28.6%, 9.3%, 12.1%, 13 months respectively. After univariate, and multivariate analyzes, Maximum Tumor Diamater (MTD)>4.5cm and number of nodule>5 were found to be independent risk factors for MIVI, and number of nodule>4 and Mean Platelet Volume (MPV)?8.6 fL were found to be independent risk factors for poor differentiation. The serum AFP levels were still normal at the recurrence time, in the 53% of the patients who had recurrence after liver transplantation, but were elevated in 47% of the recurrence patients. Conclusions: In HCC patients whose AFP level is normal before liver transplantation, independent risk factors of the presence of MİVİ, were, MTD and number of nodules, and independent risk factors of poor differentiation, were, MPV and number of nodules. Furthermore, serum AFP levels of 53% of the HCC patients whose AFP levels were normal before liver transplantation, were normal even at the recurrence time, but serum AFP levels were elevated 47% of the patients at recurrence time.
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Genel Cerrahi, General Surgery
