Relationship between Serum Hyaluronic Acid Level and Patient Prognosis in Hepatocellular Carcinoma Patients Who Underwent Hepatectomy.doc

Journal of Cancer Therapy, 2021, 4, 359-366359 ://dx.doi.org/10.4236/jct.2021.42A043 Published Online February 2021 ( :// scirp.org/journal/jct)Relationship between Serum Hyaluronic Acid Level andPatient Prognosis in Hepatocellular Carcinoma PatientsWho Underwent HepatectomyAtsushi Nanashima , Takafumi Abo, Goushi Murakami, Masaki Kunizaki, *Hiroaki Takeshita, Shigekazu Hidaka, Kazuo To, Tomoshi Tsuchiya, Takeshi Nagayasu Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.a-nanasm@nagasaki-u.ac.jp, tac-a@pop11.odn.ne.jp, mkgsmkgs@yahoo.co.jp, masaki2002@yahoo.co.jp,Email:*takehiro@nagasaki-u.ac.jp, hidaka-s@nagasaki-u.ac.jp, tokazu@nagasaki-u.ac.jp, tomoshi@nagasaki-u.ac.jp,nagayasu@nagasaki-u.ac.jpReceived November 23 , 2021; revised December 21 , 2021; accepted December 30 , 2021rd st thABSTRACTWe examined the relationship between hyaluronic acid (HA) and tumor-related factors after hepatectomy in 158 pa-tients with hepatocellular carcinoma (HCC) who underwent hepatectomy. We examined serum HA levels beforehepatectomy by evaluating data for clinicopathological parameters, surgical records, postoperative complications andsurvival. The mean HA level was 190 ± 202 ng/ml. Patients were divided into 3 groups: group A had serum HA levelsless than 50 ng/ml (normal range), group B had levels between 50 and 190 ng/ml, and group C had levels over 190ng/ml. Group C had a higher rate of poor liver function compared to others. Multiple tumors were significantly morefrequent in groups B and C compared to A. The grade of fibrosis and the inflammatory responses were positively corre-lated with the serum HA level. Postoperative long-term ascites was significantly more frequent in group C compared toothers. Although the recurrence rate and the relapse-free period were not significantly related to the serum HA level, theserum HA level was significantly associated with overall survival after hepatectomy (p < 0.05). Cox’s multivariateanalysis did not show a significant relationship between HA level and survival. Serum HA reflects progression and sur-vival in HCC patients.Keywords: Hepatocellular Carcinoma; Hepatectomy; Serum Hyaluronic Acid Level; Prognosis1. Introductionerative survival in HCC patients.The serum hyaluronic acid (HA) level is a well-knownmarker of hepatic fibrosis and hepatic sinusoidal endo-thelial function [12,13]. Our previous study also showedthat HA was significantly associated with poor hepaticfunction and postoperative complications such as long-term ascites and hepatic fibrosis [14,15]. HA might bethe most important factor related to poor hepatic func-tional reserve [16]. Therefore, we hypothesized that theserum HA level, which is a marker of reliable hepaticfunction, could be applied to predict patient survival inHCC patients. To our knowledge, the relationship be-tween the serum HA level and postoperative prognosis inHCC patients has not been examined. Identification ofthe relationship between non-tumor related factors andsurvival is useful to predict patient prognosis. We retro-spectively examined the relationship between the serumHA level and clinicopathological factors, postoperativecourse, tumor recurrence and patient survival in 156 pa-tients with HCC who underwent hepatectomy.Hepatic resection is still the most curative treatment forhepatocellular carcinoma (HCC) [1]. However, tumorrecurrence is frequent, and some patients have a poorprognosis [2]. Some factors associated with patient sur-vival have been identified [3-5]. Markers of poor hepaticfunction and tumor-related factors are significantly asso-ciated with tumor recurrence and lower survival [6-8].Our previous study showed that an advanced grade ofhepatic fibrosis, hepatitis, postoperative long-term ascitesor postoperative levels of alpha-feto protein (a marker ofchronic hepatitis) were significantly associated withshorter survival due to carcinoma after hepatectomy [9-11]. Deteriorated liver function and co-existing hepatitiswould influence tumor progression and subsequent car-cinogenesis. Therefore, reliable functional parametersidentifying deteriorated liver function or postoperativehepatic complications would be useful to predict postop-*Corresponding author.Copyright © 2021 SciRes.JCT 360Relationship between Serum Hyaluronic Acid Level and Patient Prognosis in HepatocellularCarcinoma Patients Who Underwent Hepatectomy2. Methods2.1. Patients resected specim。