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Utility of Serum YKL-40 as a Tumor-Specific Marker of Hepatobiliary Malignancies
( Ju Dong Yang ),( Eugene Kim ),( Rachel A. Pedersen ),( W. Ray Kim ),( Surakit Pungpapong ),( Lewis R. Roberts ) 대한소화기기능성질환·운동학회 2010 Gut and Liver Vol.4 No.4
Background/Aims: Serum YKL-40 has been linked to several human cancers. We investigated the potential role of serum YKL-40 as a marker of hepatobiliary malignancies. Methods: Archived serum samples of patients undergoing liver transplantation evaluation at the Mayo Clinic Rochester were used to measure YKL-40 levels. Patients were divided into three groups: hepatocellular carcinoma (HCC), cholangiocarcinoma (CCA), and end-stage liver disease (ESLD) without malignancies. The Model for ESLD (MELD) score was used to quantify the severity of liver disease. Results: The median serum YKL-40 level was highest in the ESLD group at 296 ng/mL, compared to 259 ng/mL in the HCC group and 80 ng/mL in the CCA group (p<0.01). There was a significant correlation between the MELD score and serum YKL-40 level (r=0.50, p<0.01). In a multivariate analysis, there was no significant difference in serum YKL-40 level between ESLD and HCC. CCA was associated with lower YKL-40 levels, a finding that was attributable to a lower prevalence of cirrhosis. Conclusions: The serum YKL-40 level has little utility as a cross-sectional screening tool for hepatobiliary malignancies, namely HCC and CCA. The role of YKL-40 as a surveillance marker in the follow-up of individual patients remains to be determined. (Gut Liver 2010;4:537-542)
Model to estimate survival in ambulatory patients with hepatocellular carcinoma
Yang, Ju Dong,Kim, W. Ray,Park, Kyung Woo,Chaiteerakij, Roongruedee,Kim, Bohyun,Sanderson, Schuyler O.,Larson, Joseph J.,Pedersen, Rachel A.,Therneau, Terry M.,Gores, Gregory J.,Roberts, Lewis R.,Park Wiley Subscription Services, Inc., A Wiley Company 2012 Hepatology Vol.56 No.2
<P><B>Abstract</B></P><P>Survival of patients with hepatocellular carcinoma (HCC) is determined by the extent of the tumor and the underlying liver function. We aimed to develop a survival model for HCC based on objective parameters including the Model for Endstage Liver Disease (MELD) as a gauge of liver dysfunction. This analysis is based on 477 patients with HCC seen at Mayo Clinic Rochester between 1994 and 2008 (derivation cohort) and 904 patients at the Korean National Cancer Center between 2000 and 2003 (validation cohort). Multivariate proportional hazards models and corresponding risk score were created based on baseline demographic, clinical, and tumor characteristics. Internal and external validation of the model was performed. Discrimination and calibration of this new model were compared against existing models including Barcelona Clinic Liver Cancer (BCLC), Cancer of the Liver Italian Program (CLIP), and Japan Integrated Staging (JIS) scores. The majority of the patients had viral hepatitis as the underlying liver disease (100% in the derivation cohort and 85% in the validation cohort). The survival model incorporated MELD, age, number of tumor nodules, size of the largest nodule, vascular invasion, metastasis, serum albumin, and alpha‐fetoprotein. In cross‐validation, the coefficients remained largely unchanged between iterations. Observed survival in the validation cohort matched closely with what was predicted by the model. The concordance (c)‐statistic for this model (0.77) was superior to that for BCLC (0.71), CLIP (0.70), or JIS (0.70). The score was able to further classify patient survival within each stage of the BCLC classification. <I>Conclusion</I>: A new model to predict survival of HCC patients based on objective parameters provides refined prognostication and supplements the BCLC classification. (H<SMALL>EPATOLOGY</SMALL> 2012)</P>