scholarly journals Serum Albumin Levels in Relation to Tumor Parameters in Hepatocellular Carcinoma Patients

2017 ◽  
Vol 32 (4) ◽  
pp. 391-396 ◽  
Author(s):  
Brian I. Carr ◽  
Vito Guerra
Keyword(s):  
Hepatocellular Carcinoma ◽  
Serum Albumin ◽  
Prognostic Significance ◽  
Tumor Diameter ◽  
Lower Serum ◽  
Vein Thrombosis ◽  
Inflammatory Index ◽  
Tumor Multifocality ◽  
Relationship Of ◽  
Low Serum

Background Serum albumin levels have been shown to have prognostic significance in hepatocellular carcinoma (HCC), as part of an inflammatory index. The aim of this study was to examine the possible relationship of serum albumin levels to parameters of HCC aggressiveness. Methods A large HCC patient cohort was retrospectively examined, and the possible relationships of albumin levels to tumor diameter, multifocality, portal vein thrombosis (PVT) and α-fetoprotein levels were examined. Results HCC patients with lower serum albumin levels had significantly larger maximum tumor diameters, greater prevalence of PVT, increased tumor multifocality and higher α-fetoprotein levels, than HCC patients with higher albumin levels. A correlation was found between levels of these tumor parameters and serum albumin levels. Conclusions These results indicate that low serum albumin levels correlate with increased parameter measures of HCC aggressiveness, in addition to their role as a monitor of systemic inflammation. Decreased serum albumin might have a role in HCC aggressiveness.

scholarly journals Changes in hepatocellular carcinoma aggressiveness characteristics with an increase in tumor diameter

2021 ◽  
pp. 172460082199637
Author(s):  
Brian I. Carr ◽  
Vito Guerra ◽  
Rossella Donghia ◽  
Fabio Farinati ◽  
Edoardo G. Giannini ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Survival Data ◽  
Alpha Fetoprotein ◽  
Tumor Diameter ◽  
Vein Thrombosis ◽  
Tumor Multifocality ◽  
Maximum Tumor Diameter ◽  
Tumor Sampling

Background: Hepatocellular carcinoma prognosis depends on both liver and tumor determinants, especially on maximum tumor diameter, multifocality, and presence of portal vein thrombosis, despite apparently complete tumor removal by resection or liver transplantation. Aims: To examine parameters of hepatocellular carcinoma aggressiveness as tumor size increases. Methods: A large hepatocellular carcinoma database was examined for trends in serum alpha-fetoprotein and the percentage of patients with macroscopic portal vein thrombosis or tumor multifocality. Results: A total of 13,016 hepatocellular carcinoma patients were identified having full tumor and survival data. Of these, 76.56% were male and 23.44% were female, with a median age of 64.4 years. We found that as the maximum tumor diameter increased, there was a significant trend for increased alpha-fetoprotein levels ( P<0.001) and an increased percentage of patients with either portal vein thrombosis or tumor multifocality, each P<0.0001. Furthermore, the increases of both alpha-fetoprotein and portal vein thrombosis were proportionately greater than the related maximum tumor diameter increases. These trends of increased alpha-fetoprotein, portal vein thrombosis, and multifocality with increasing maximum tumor diameter had non-linear patterns. Within alpha-fetoprotein and multifocality trends, there were identifiable sub-trends associated with specific maximum tumor diameter ranges. Conclusions: The greater fold-increases in alpha-fetoprotein and portal vein thrombosis compared with increases in maximum tumor diameter imply that hepatocellular carcinoma characteristics may change with increasing size to a more aggressive phenotype, suggesting that follow-up tumor sampling might be useful, in addition to baseline tumor sampling, for optimal therapeutic choices to be made.

scholarly journals Macroscopic Portal Vein Thrombosis in HCC Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Hikmet Akkiz ◽  
Brian I. Carr ◽  
Sedef Kuran ◽  
Ümit Karaoğullarından ◽  
Oguz Üsküdar ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Odds Ratio ◽  
Logistic Regression Model ◽  
Tumor Diameter ◽  
Portal Vein Invasion ◽  
Vein Thrombosis ◽  
Tumor Multifocality ◽  
Maximum Tumor Diameter ◽  
Low Levels

Macroscopic portal vein invasion (PVT) by hepatocellular carcinoma (HCC) in the liver is one of the most important negative prognostic factors for HCC patients. The characteristics of a large cohort of such patients were examined. We found that the percent of patients with PVT significantly increased with increasing maximum tumor diameter (MTD), from 13.7% with tumors of MTD <5cm to 56.4% with tumors of MTD >10cm. There were similar numbers of HCC patients with very large tumors with and without PVT. Thus, MTD alone was insufficient to explain the presence of PVT, as were high AFP levels, since less than 50% of high AFP patients had PVT. However, the percent of patients with PVT was also found to significantly increase with increasing blood alpha-fetoprotein (AFP) levels and tumor multifocality. A logistic regression model that included these 3 factors together showed an odds ratio of 17.9 for the combination of MTD>5.0cm plus tumor multifocality plus elevated AFP, compared to low levels of these 3 parameters. The presence or absence of macroscopic PVT may therefore represent different HCC aggressiveness phenotypes, as judged by a significant increase in tumor multifocality and AFP levels in the PVT positive patients. Factors in addition to MTD and AFP must also contribute to PVT development.

scholarly journals Identification of Clinical Phenotypes and Related Survival in Patients with Large HCCs

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 592
Author(s):  
Brian I. Carr ◽  
Vito Guerra ◽  
Rossella Donghia ◽  
Fabio Farinati ◽  
Edoardo G. Giannini ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Tumor Diameter ◽  
Clinical Phenotypes ◽  
Vein Thrombosis ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Tumor Multifocality ◽  
Serum Alpha Fetoprotein ◽  
Maximum Tumor Diameter ◽  
Cox Analysis

Background. Hepatocellular carcinoma (HCC) factors, especially maximum tumor diameter (MTD), tumor multifocality, portal vein thrombosis (PVT), and serum alpha-fetoprotein (AFP), influence survival. Aim. To examine patterns of tumor factors in large HCC patients. Methods. A database of large HCC patients was examined. Results. A multiple Cox proportional hazard model on death identified low serum albumin levels and the presence of PVT and multifocality, with each having a hazard ratio ≥2.0. All combinations of these three parameters were examined in relation to survival. Using univariate Cox analysis, the combination of albumin >3.5 g/dL and the absence of both PVT and multifocality had the best survival rate, while all combinations that included the presence of PVT had poor survival and hazard ratios. We identified four clinical phenotypes, each with a distinct median survival: patients with or without PVT or multifocality plus serum albumin ≥3.5 (g/dL), with each subgroup displaying high (≥100 IU/mL) or low (<100 IU/mL) blood AFP levels. Across a range of MTDs, we identified only two significant trends, blood AFP and platelets. Conclusions. Patients with large HCCs have distinct phenotypes and survival, as identified by the combination of PVT, multifocality, and blood albumin levels.

Hypoalbuminemia Is An Independent Prognostic Factor In Myelodysplastic Syndromes

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4001-4001
Author(s):  
Maria Corrales-Yepez ◽  
Mohamed A. Kharfan-Dabaja ◽  
Jeffrey Lancet ◽  
Alan F. List ◽  
Eric Padron ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Serum Albumin ◽  
Serum Albumin Level ◽  
Risk Group ◽  
Risk Groups ◽  
Albumin Level ◽  
Refractory Anemia ◽  
Lower Serum ◽  
Kaplan Meier ◽  
Low Serum

Abstract Abstract 4001 Background: Low serum albumin level is known to be an adverse prognostic factor in patients with malignancies such as multiple myeloma. We previously reported that severe hypoalbuminemia (&lt;3.0 g/dl) at day +90 post allogeneic hematopoietic stem cell transplant (AHCT) was an independent predictor of non-relapse and overall mortality in patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) (Kharfan-Dabaja et al Biol Blood Marrow Transplant. 2010 Jul). In this study we examined prognostic value of serum albumin level in patients with MDS. Methods: Data were analyzed from the Moffitt Cancer Center (MCC) MDS database with chart review verification. The primary objective was to examine the role of serum albumin at time of presentation to MCC as a prognostic marker for overall survival (OS). Patients were divided into 3 groups of serum albumin levels (≤ 3.5, 3.6–4.0 and &gt; 4.0 g/dl). The Kaplan–Meier method was used to estimate median OS. The log rank test was used to compare Kaplan–Meier survival estimates between two groups. Cox proportional hazards regression was used for multivariable analysis. Results: Between January 2001 and December 2009, 844 patients were captured by the MCC MDS database. The median age was 69 years. MDS subtypes were coded as refractory anemia (RA) (n=98;12%), refractory anemia with ring sideroblasts (RARS) (n=76;9%), del(5q) (n=20;2.4%), refractory cytopenia with multi-lineage dysplasia (RCMD) (n=96;11%), refractory anemia with excess blasts (RAEB) (n=255;30%), therapy related MDS (n=22;2.6%), and MDS-NOS (n=275; 33%). The distribution of IPSS risk groups was: 18.7% Low risk, 42.9% Intermediate-1 (Int-1), 19.9% Int-2, 5.3% High risk, and 13.2% unknown. Baseline characteristics for the three patient groups defined by serum albumin level are summarized in (Table-1). There was no difference in red blood cell transfusion dependency (RBC-TD) rate between the 3 groups (p=0.21). The median OS for all patients was 36 months (95% confidence interval (CI) 31.5–40.5 mo). Age, IPSS risk group, RBC-TD, Serum ferritin were statistically significant prognostic factors in univariable analysis. The median OS was 19 mo (95%CI= 14.9–23.1 mo), 35 mo (95%CI= 28.7–41.3 mo), and 53 mo (95%CI= 44.7–61.3 mo) for patients with serum albumin levels ≤ 3.5 g/dl, 3.6–4.0 g/dl, &gt; 4.0 g/dl, respectively. (Figure-1) (p= &lt;0.005). After adjustment for age, RBC-TD, OS was statistically significantly inferior among MDS patients with lower serum albumin (Hazard Ratio (HR) = 0.79.; 95%CI= 0.69–0.90; p= 0.001), and higher-risk IPSS group (HR=1.67; 95%CI=1.48-1.87; p= &lt;0.005). The overall rate of AML transformation was 29.2%. Rate of AML transformation was higher in patients with lower serum albumin, 38% in patients with serum albumin ≤ 3.5 g/dl, 30% for patients 3.6–4.0 g/dl, and 23% in patients with serum albumin &gt; 4.0 g/dl (p-value 0.005). Among patients in the Low/Int-1 IPSS risk group, the median OS was 28 mo (95%CI=15.7-40.3 mo), 48 mo (95%CI=38.8-58.0 mo), and 60 mo (95%CI=47.6-72.4 mo) for patients with serum albumin levels ≤ 3.5 g/dl, 3.6–4.0 g/dl and &gt; 4.0 g/dl, respectively (p=0.003). Among patients in the Int-2/High IPSS risk group, the median OS was 16 mo (95%CI 13.3–15.7 mo), 22 mo (95%CI 18.0–26.0 mo), and 21 mo (95%CI 8.8–33.2 mo) respectively for patients with serum albumin levels ≤ 3.5 g/dl, 3.6–4.0 g/dl and &gt; 4.0 g/dl, respectively p=0.03). Conclusion: In this retrospective analysis of a large single institution MDS database, serum albumin is found to be an independent prognostic factor for OS and AML transformation in MDS patients. The prognostic power of low serum albumin was greatest among patients with Low/Int-1 IPSS risk group, but remained an independent variable across all risk groups. Serum albumin may also be a surrogate marker of general health, co- morbidities, and performance status. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The Expression of Circulating miR-497 and Metadherin in Hepatocellular Carcinoma: Relation to the Tumor Characteristics and Patients’ Survival

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 866
Author(s):  
Dina A. Ali ◽  
Nesreen M. Sabry ◽  
Ahmed M. Kabel ◽  
Rasha A. Gaber ◽  
Hwaida M. Mokhtar ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Prognostic Significance ◽  
Nodal Metastasis ◽  
Rank Test ◽  
Tumor Characteristics ◽  
Test Results ◽  
Relative Expression ◽  
Kaplan Meier ◽  
Relationship Of

Objectives: This study aimed to evaluate the prognostic significance and relationship of miR-497 and metadherin to hepatocellular carcinoma (HCC) tumor characteristics and patients’ survival. Methods: This study enrolled 120 (60 HCC patients and 60 healthy) subjects. Serum miR-497 and metadherin mRNA relative expression were analyzed by real-time quantitative reverse transcription polymerase chain reaction. The overall survival (OS) of HCC patients was assessed using the Kaplan–Meier curve and log-rank test. Results: Serum miR-497 showed statistically significant downregulation in HCC patients compared to controls (p < 0.001). Serum metadherin mRNA relative expression was significantly upregulated in HCC patients compared to controls (p < 0.001). Both serum miR-497 and metadherin mRNA expression were significantly associated with the number of tumor foci (p = 0.028 and 0.001, respectively), tumor size (p = 0.022 and <0.001, respectively), nodal metastasis (p = 0.003 and 0.003, respectively), distant metastasis (p = 0.003 and 0.003, respectively), vascular invasion (p = 0.040 and <0.001, respectively), and BCLC staging (p = 0.043 and 0.004, respectively). The overall survival was lower in patients with low miR-497 expression (p = 0.046) and in patients with high metadherin expression (p < 0.001). Conclusions: The expression levels of miR-497 showed downregulation in HCC patients, but metadherin expression showed upregulation. Both markers were inversely related and closely correlated with tumor characteristics and patients’ survival.

scholarly journals 933. Serum Albumin Is Associated With Higher Inflammation and Carotid Atherosclerosis in Treated HIV Infection

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S32-S32
Author(s):  
Sahera Dirajlal-Fargo ◽  
Manjusha Kulkarni ◽  
Abdus Sattar ◽  
Nicholas Funderburg ◽  
Grace A McComsey
Keyword(s):  
T Cell ◽  
Serum Albumin ◽  
Carotid Atherosclerosis ◽  
Surrogate Marker ◽  
Research Support ◽  
Lower Serum ◽  
Time Points ◽  
Markers Of Inflammation ◽  
D Dimer ◽  
Low Serum

Abstract Background Lower serum albumin has recently been associated with cardiovascular disease and non-AIDS malignancies in HIV. This analysis explores the associations between serum albumin and markers of inflammation and atherosclerosis. Methods We conducted a nested study within in the SATURN-HIV trial in which 147 HIV+ adults on stable antiretroviral therapy (ART), were virally suppressed, and had an LDL-cholesterol level &lt;130 mg/dL were randomized to 10 mg daily rosuvastatin or placebo. Measures of serum albumin, carotid intima media thickness (IMT, surrogate marker of atherosclerosis), inflammation, T-cell and monocyte immune activation were assessed at baseline, 24, 48, and 96 weeks later. Spearman correlations and linear-mixed effects models with random intercept and slope were conducted to assess associations with albumin. Results Mean age was 45 years, 80% were male, 69% were African American, and 46% were receiving protease inhibitors. Mean serum albumin was not significantly different between the groups at any time points (4.05–4.08 g/dL in statin arm vs. 4.01–4.11 g/dL in placebo arm, P = 0.08–0.35). Low serum albumin significantly correlated with elevated levels of interleukin-6 (IL6), d-dimer, fibrinogen, and high sensitivity C-reactive protein (hsCRP) at all time points (P ≤ 0.04). Low serum albumin also correlated with higher inflammatory monocytes (CD14+CD16+) at week 24 and week 96 (P ≤ 0.03) but not with markers of T-cell activation at any time point (P ≥ 0.10). Lower baseline albumin significantly predicted larger changes in IMT (P = 0.03), IL6, d-dimer, tumor necrosis factor-α receptor 1, fibrinogen, and hsCRP (P ≤ 0.02) over 96 weeks. After adjusting for age, gender, smoking, body mass index, vascular cell adhesion molecule and creatinine clearance, every 1 g/dL decrease in albumin remained associated with a 0.5 mm increase in IMT over 96 weeks (P = 0.05). Conclusion Lower serum albumin in controlled HIV is associated with higher markers of chronic inflammation, hypercoagulation, and monocyte activation, which could explain the prior observation that albumin predicts non-AIDS events in HIV. Our findings suggest that serum albumin may predict progression of carotid atherosclerosis independent of traditional risk factors. Disclosures G. A McComsey, Gilead: Consultant, Consulting fee and Research support. Merck: Consultant, Consulting fee and Research support. Viiv: Consultant, Consulting fee and Research support. Roche: Research Contractor, Research support. Astellas: Research Contractor, Research support.

scholarly journals Association of Low Serum Albumin Level with Higher Hepatocellular Carcinoma Recurrence in Patients with Hepatitis B Virus Pre-S2 Mutant after Curative Surgical Resection

2021 ◽  
Vol 10 (18) ◽  
pp. 4187
Author(s):  
Long-Bin Jeng ◽  
Tsai-Chung Li ◽  
Shih-Chao Hsu ◽  
Wen-Ling Chan ◽  
Chiao-Fang Teng
Keyword(s):  
Hepatocellular Carcinoma ◽  
Serum Albumin ◽  
Surgical Resection ◽  
Serum Albumin Level ◽  
Gene Segment ◽  
Albumin Level ◽  
Clinicopathological Factors ◽  
B Virus ◽  
Hcc Recurrence ◽  
Low Serum

Hepatocellular carcinoma (HCC) is, globally, one of the most prevalent and deadly human cancers; despite curative surgical resection, its high recurrence rate after surgery remains a large threat, resulting in poor patient survival. The hepatitis B virus (HBV) pre-S2 mutant that harbors deletions spanning the pre-S2 gene segment has emerged as an important oncoprotein for HCC development and a valuable prognostic biomarker for HCC recurrence; however, its relationship with clinicopathological factors is largely unexplored. In this study, the correlation of the deletion spanning the pre-S2 gene segment with clinicopathological factors and the association of such correlation with HCC recurrence after curative surgical resection were examined in HBV-related HCC patients. Inverse correlation between serum albumin level and the deletion spanning the pre-S2 gene segment was identified. HCC patients with the presence of the deletion spanning the pre-S2 gene segment and a low serum albumin level were associated with higher HCC recurrence than patients with either factor alone or neither factor were. Moreover, a combination of the serum albumin level and the deletion spanning the pre-S2 gene segment exhibited better performance than that of either factor alone in predicting HCC recurrence. Collectively, this study shows an association of low serum albumin level with pre-S2 mutant-positive HCC patients, and validates the prognostic value of this association in identifying patients with higher HCC recurrence after curative surgical resection.

Predictive Value of Serum Albumin Level for the Prognosis of Severe Sepsis Without Exogenous Human Albumin Administration: A Prospective Cohort Study

2016 ◽  
Vol 33 (12) ◽  
pp. 687-694 ◽  
Author(s):  
Mei Yin ◽  
Lei Si ◽  
Weidong Qin ◽  
Chen Li ◽  
Jianning Zhang ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Serum Albumin ◽  
Operating Characteristic ◽  
Human Albumin ◽  
Albumin Level ◽  
Apache Ii ◽  
Confounding Effect ◽  
Lower Serum ◽  
Albumin Administration ◽  
Low Serum

Background: The prognostic significance of serum albumin levels in patients with sepsis has previously been reported; however, these studies have not excluded the potential confounding effect of exogenous albumin administration. In this study, we investigate the predictive value of serum albumin for the prognosis of severe sepsis without the interference of exogenous albumin administration. Methods: A prospective cohort study was conducted from April to November 2014 in the internal and surgical intensive care units of a tertiary care hospital. During the study period, due to a supply shortage, patients were not treated with human albumin. Serum albumin levels were measured, and laboratory and clinical data were collected at the onset of severe sepsis. Prognostic factors were analyzed using receiver operating characteristic curve and multivariate Cox proportional hazard regression analysis. Survival was assessed by Kaplan-Meier method. Results: One hundred sixteen patients were included in the study. The overall 28-day mortality was 26.7%. The most common infection sources were lower respiratory tract, abdomen/pelvis, and bloodstream. Compared to patients who survived, those who died had lower serum albumin levels and higher Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores. Receiver operating characteristic curves demonstrate that albumin level is a strong predictor of 28-day mortality, and the optimal cutoff value maximizing sensitivity and specificity is 29.2 g/L. Through multivariate Cox regression analysis, low serum albumin levels (<29.2 g/L) and APACHE II scores are identified as independent risk factors for mortality. Patients with lower serum albumin levels more often had abdominal/pelvic sources of infection, acute kidney or liver injury, septic shock, and higher APACHE II and SOFA scores. The 28-day survival rate was lower for patients with serum albumin below 29.2 g/L than for patients with serum albumin at or above this level. Conclusion: Having excluded potential confounding effect of exogenous albumin administration, low serum albumin levels are associated with an increased risk of death in patients with severe sepsis.

High-risk factors affecting survival after transcatheter therapy with doxorubicin-eluting beads for unresectable hepatocellular carcinoma

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15614-e15614
Author(s):  
J. K. West ◽  
R. Dhanasekaran ◽  
D. A. Kooby ◽  
C. A. Staley ◽  
J. Kauh ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Portal Vein ◽  
Serum Albumin ◽  
Portal Vein Thrombosis ◽  
Survival Rates ◽  
Transcatheter Therapy ◽  
Vein Thrombosis ◽  
One Year

e15614 Background: Transcatheter therapy with drug eluting beads (DEB) with Doxorubicin is a relatively new modality of palliative treatment of patients with unresectable HCC. It is important to identify prognostic factors which affect survival after treatment with DEB to enable optimal patient selection and to ensure maximal survival benefit. Methods: Fifty consecutive patients with unresectable HCC who were treated with transcatheter therapy with DEB between the period of 2005 and 2008 were studied. Kaplan Meier test was used to study survival. Categorical variables were compared with Log rank test and continuous variable with Cox proportional hazards method. Results: The survival rates at one year from first transcatheter therapy in patients belonging to Okuda stage I, II and III were 67%, 35% and 27% (p=0.043). The survival rates at one year from the first transcatheter therapy in Child Pugh Class A, B and C were 60%, 39% and 13% (p=0.003). Portal vein thrombosis was present in 24%(12/50). Median survivals in patients with and without portal vein thrombosis were 335 days(31–638) and 610 days(482–738)(p=0.285). The median survival in patients with tumor thrombus and bland thrombus were 169 days and 335 days(p=0.69). The median survival in patients with main portal vein thrombosis and branch portal vein thromboses were 316 days(135–497) and 550 days(202–897)(p=0.89).Pre- procedure albumin, bilirubin and MELD score were found to be prognostic factors on univariate analysis ( Table 1 ).On multivariate analysis, pre-procedure serum albumin and Okuda staging were found to be independent prognostic factors. Conclusions: On multivariate analysis, serum albumin and Okuda staging were found to independently influence survival of patients treated with Doxorubicin eluting beads for unresectable hepatocellular carcinoma. The presence of portal vein thrombosis did not affect the long term survival. [Table: see text] No significant financial relationships to disclose.

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