The association between pretreatment serum alkaline phosphatase and prognosis in hepatocellular carcinoma

Abstract

Background: Numerous studies have investigated the association between pretreatment serum alkaline phosphatase (ALP) and prognosis in hepatocellular carcinoma (HCC), but conclusions remain controversial. Thus, we performed a meta-analysis to assess systematically the relationship between ALP and prognosis in HCC. Methods: We searched the PubMed, EMBASE, and Web of Science databases for eligible studies up to October. A combined hazard ratio (HR) was determined to describe the correlation between pretreatment serum ALP level and prognosis in HCC patients. Overall survival (OS) was calculated from the date of treatment either to the end point of the follow-up period or to the date of death by any cause. Disease-free survival (DFS) and recurrence-free survival (RFS) were defined as the period from the date of treatment to the date of last follow-up or to the date of recurrence. OS was regarded as the major outcome. Results: Altogether, 21 studies about OS and 6 studies about DFS/RFS were included in this meta-analysis. Our combined results showed that there was an inverse association of pretreatment serum ALP level with OS (HR=1.15, 95% CI: 1.12–1.19) and RFS (HR=1.78, 95% CI: 1.37–2.31). Conclusion: There was a close association between high pretreatment ALP level and poor survival in HCC patients, indicating that ALP may be used as a biomarker for prognosis. More high-quality studies are required to validate our findings further, considering the limitations of our meta-analysis.

Development and Validation of a Vascular Endothelial Growth Factor A-associated Prognostic Model for Unresectable Hepatocellular Carcinoma

“… 58 , 59 A meta-analysis included 27 studies and found that higher serum ALP levels in HCC patients may be associated with a worse prognosis. 60 Abnormally heightened ALP level was found to have predicted a worse survival rate. 61 Here, we again confirmed the potential roles of ALP in predicting the prognosis of patients with HCC.…”

Simple parameters predicting extrahepatic recurrence after curative hepatectomy for hepatocellular carcinoma

“…Although there is still controversy concerning the association between the ALP level and HCC prognosis, a recent study showed that the serum ALP levels increase in liver disease and may reflect liver injury 33 . A recent meta-analysis showed that high pre-treatment ALP levels were significantly associated with poor overall survival rate (HR: 1.14, 95% CI: 1.10–1.18) and RFS (HR: 1.78, 95% CI: 1.37–2.31) 34 . This finding was concordant with our present result presenting an association of higher ALP level with early EHR.…”

Liver stiffness measured by magnetic resonance elastography in early recurrence of hepatocellular carcinoma after treatment

“…[ 3 – 5 ] Although these treatments improve the therapeutic effects of HCC, recurrence is still common after treatment, thus resulting in a low survival rate. [ 6 , 7 ]…”

“…[3][4][5] Although these treatments improve the therapeutic effects of HCC, recurrence is still common after treatment, thus resulting in a low survival rate. [6,7] Magnetic resonance elastography (MRE), known as "'image palpation," is a new noninvasive imaging technique. [8,9] Mechanical waves can be used to quantitatively quantify the degree of liver fibrosis, fat content and iron content.…”

“…The treatment of HCC includes liver transplantation, microwave ablation, radiofrequency ablation, and hepatectomy [3–5] . Although these treatments improve the therapeutic effects of HCC, recurrence is still common after treatment, thus resulting in a low survival rate [6,7] …”