Analysis of aggressiveness factors in hepatocellular carcinoma patients undergoing transarterial chemoembolization

Table 1 Multiple logistic regression of aggressiveness index (score = 4/score > 4) on liver function parameter

All models in total cohort	OR	se(OR)	P value	95%CI
Variables included together in the model
Total Bilirubin (mg/dL)	2.044	0.875	0.095	0.883 to 4.729
ALKP (IU/mL)	1.013	0.006	0.046	1.000 to 1.025
GGTP (IU/mL)	0.995	0.002	0.045	0.990 to 0.999
AST (IU/L)	1.002	0.003	0.442	0.996 to 1.009
Albumin (g/dL)	3.197	1.74	0.033	0.101 to 9.288
Platelets (× 109/L)	1.014	0.008	0.056	1.000 to 1.029
WBC (× 109/L)	0.811	0.121	0.158	0.606 to 1.085
Lymphocyte (× 109/L)	1.311	0.354	0.315	0.773 to 2.227
Final model from stepwise method in backward
ALKP (IU/mL)	1.014	0.006	0.017	1.003 to 1.026
GGTP (IU/mL)	0.996	0.002	0.053	0.991 to 1.000
Albumin (g/dL)	2.562	1.082	0.026	1.120 to 5.863

Aggressiveness index (sum of scores): MTD (in tertiles): MTD < 4.5; 4.5 ≤ MTD ≤ 9.6; MTD > 9.6; scores 1, 2, 3 respectively; AFP (cut-off): AFP < 100; 100 ≤ AFP ≤ 1000; AFP > 1000; scores 1, 2, 3 respectively; PVT (no/yes): PVT (no); PVT (yes); scores 1, 3 respectively; nodules (number): Nodules ≤ 3; nodules > 3; scores 1, 3 respectively. AFP: Alpha-fetoprotein; MTD: Maximum tumor diameter; PVT: Portal vein thrombosis; ALKP: Alkaline phosphatase; GGTP: Gamma glutamyl transpeptidae; AST: Aspartate aminotransaminase; Hb: Haemoglobin; Plt: Platelet count; WBC: White blood cell.

Table 2 Characteristics of patients in the total cohort

Parameter1	Value
Age (yr)	64.24 ± 10.35
Sex (M) (%)	124 (74.25)
Cirrhosis (yes) (%)	134 (80.24)
AFP (ng/dL)	1769.49 ± 7297.65
AFP (median, range)	53.80 (1-66000)
AFP > 100 (%)	54 (40.60)
Number nodules	1.95 ± 1.39
MTD (cm)	4.45 ± 2.64
PVT (yes) (%)	24 (14.37)
Aggressiveness index score (%)
Score > 4	75 (63.56)
Total bilirubin (mg/dL)	1.23 ± 0.80
ALKP (IU/mL)	133.29 ± 74.74
GGTP (IU/mL)	152.26 ± 152.80
AST (IU/L)	104.68 ± 110.73
ALT (IU/L)	77.85 ± 88.25
Albumin (g/dL)	3.63 ± 1.93
Platelet count (× 109/L)	113.78 ± 82.70
WBC (× 109/L)	5.46 ± 2.59
Lymphocyte (× 109/L)	1.41 ± 0.98
Survival time (median, range)	38 (3-175)

¹All values: mean ± SD for continuous variables; Aggressiveness Index (sum of scores): MTD (in tertiles): MTD < 4.5; 4.5 ≤ MTD ≤ 9.6; MTD > 9.6; scores 1, 2, 3 respectively; AFP (cut-off): AFP < 100; 100 ≤ AFP ≤1000; AFP > 1000; scores 1, 2, 3 respectively; PVT (no/yes): PVT (no); PVT (yes); scores 1, 3 respectively; Nodules (number): Nodules ≤ 3; Nodules > 3; scores 1, 3 respectively. AFP: Alpha-fetoprotein; MTD: Maximum tumor diameter; PVT: Portal vein thrombosis; ALKP: Alkaline phosphatase; GGTP: Gamma glutamyl transpeptidae; AST: Aspartate aminotransaminase; ALT: Alanina amminotransferasi; Hb: Haemoglobin; WBC: White blood cell.

Table 3 Cox proportional hazard model for death on aggressiveness index score and liver function parameters

All models in total cohort	HR	se(HR)	P value	95%CI
Variables included together in the model
Aggressiveness Index
Score = 4 [Ref. category]	1	-	-	-
Score > 4	2.185	0.757	0.024	1.108 to 4.310
Total bilirubin (mg/dL)	0.985	0.154	0.925	0.725 to 1.339
ALKP (IU/mL)	0.999	0.003	0.793	0.993 to 1.005
GGTP (IU/mL)	1.003	0.001	0.016	1.001 to 1.006
AST (IU/L)	0.999	0.002	0.511	0.995 to 1.003
Albumin (g/dL)	0.793	0.250	0.462	0.427 to 1.472
Platelets (×109/L)	1.002	0.002	0.161	0.999 to 1.006
Final model from stepwise method in backward
Aggressiveness Index
Score = 4 [Ref. category]	1	-	-	-
Score > 4	2.263	0.748	0.013	1.184 to 4.327
GGTP (IU/mL)	1.003	0.001	0.001	1.001 to 1.004

Aggressiveness index (sum of scores): MTD (in tertiles): MTD < 4.5; 4.5 ≤ MTD ≤ 9.6; MTD > 9.6; scores 1, 2, 3 respectively; AFP (cut-off): AFP < 100; 100 ≤ AFP ≤ 1000; AFP > 1000; scores 1, 2, 3 respectively; PVT (no/yes): PVT (no); PVT (yes); scores 1, 3 respectively; nodules (number): Nodules ≤ 3; nodules > 3; scores 1, 3 respectively. AFP: Alpha-fetoprotein; MTD: Maximum tumor diameter; PVT: Portal vein thrombosis; ALKP: Alkaline phosphatase; GGTP: gamma glutamyl transpeptidae; AST: Aspartate aminotransaminase; Hb: Haemoglobin; Plt: Platelet count.

Table 4 Comparisons in hepatocellular carcinoma patients among dichotomization of gamma glutamyl transpeptidase (≤ 100/> 100 IU/L), in the total cohort

	GGTP (IU/L)
Parameter1	≤ 100 (n = 81) (50.31%)	> 100 (n = 80) (49.69%)	P2 value
Total bilirubin (mg/dL)	1.25 ± 0.75	1.19 ± 0.87	0.17
ALKP (IU/mL)	104.55 ± 42.06	160.92 ± 89.79	< 0.0001
GGTP (IU/mL)	55.44 ± 24.46	250.29 ± 165.35	< 0.0001
AST (IU/L)	93.61 ± 79.10	115.45 ± 137.27	0.06
Albumin (g/dL)	3.70 ± 2.68	3.56 ± 0.57	0.13
Platelets (× 109/L)	100.14 ± 61.45	129.60 ± 100.06	0.02
Aggressiveness index (%)
Score > 4	33 (56.90)	42 (75.00)	0.043
Survival at time (%)
1 yr	68 (87.18)	54 (70.13)	0.013
2 yr	52 (66.67)	37 (48.05)	0.023
3 yr	39 (50.00)	25 (32.47)	0.033

¹All values: mean ± SD;

²Wilcoxon rank-sum (Mann-Whitney) test;

³Test Z for proportions. Aggressiveness index (sum of scores): MTD (in tertiles): MTD < 4.5; 4.5 ≤ MTD ≤ 9.6; MTD > 9.6; scores 1, 2, 3 respectively; AFP (cut-off): AFP < 100; 100 ≤ AFP ≤ 1000; AFP > 1000; scores 1, 2, 3 respectively; PVT (no/yes): PVT(no); PVT(yes); scores 1, 3 respectively; nodules (number): Nodules ≤ 3; nodules > 3; scores 1, 3 respectively. AFP: Alpha-fetoprotein; MTD: Maximum tumor diameter; PVT: Portal vein thrombosis; ALKP: Alkaline phosphatase; GGTP: Gamma glutamyl transpeptidae; AST: Aspartate aminotransaminase; Hb: Haemoglobin; Plt: Platelet count.