Prospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2025; 17(2): 99092
Published online Feb 27, 2025. doi: 10.4254/wjh.v17.i2.99092
Thyroid hormone, immunoglobin and complements for predicting hepatocellular carcinoma development in patients with hepatitis B virus-related liver cirrhosis
Xue-Cheng Tong, Kai Liu, Ze-Yu Huang, Xiu-Jun Zhang, Yuan Xue
Xue-Cheng Tong, Kai Liu, Ze-Yu Huang, Xiu-Jun Zhang, Yuan Xue, Department of Infectious Diseases, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
Co-first authors: Xue-Cheng Tong and Kai Liu.
Co-corresponding authors: Xiu-Jun Zhang and Yuan Xue.
Author contributions: Tong XC and Liu K contributed equally to this work; Tong XC, Liu K, and Huang ZY collected and confirmed the data, analyzed the data and drafted the manuscript; Zhang XJ and Xue Y conceived and designed the study, and revised the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Supported by The Research Foundation of Jiangsu Province Administration of Traditional Chinese Medicine, No. MS2023088; The Science and Technology Project of Changzhou, No. CE20225040; The Research Foundation of Nanjing Medical University Changzhou Medical Center, No. CMCC202311; and Leading Talent of Changzhou “The 14th Five-Year Plan” High-Level Health Talents Training Project, No. 2022CZLJ021.
Institutional review board statement: The study was approved by the Ethics Committee of The Third People’s Hospital of Changzhou.
Clinical trial registration statement: This study aims to investigate risk factors for outcomes of patients with liver cirrhosis or acute-on-chronic liver failure. The study is registered at Chinese Clinical Trial Registry. The registration number is ChiCTR1900025822.
Informed consent statement: Written informed consent was obtained from all participants.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuan Xue, MD, Chief Doctor, Department of Infectious Diseases, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, No. 300 Lanling North Road, Changzhou 213000, Jiangsu Province, China. xueyuan80908@163.com
Received: July 13, 2024
Revised: January 6, 2025
Accepted: January 24, 2025
Published online: February 27, 2025
Processing time: 221 Days and 14 Hours
Abstract
BACKGROUND

Hepatocellular carcinoma (HCC) surveillance is crucial for patients with compensated cirrhosis (CC) and decompensated cirrhosis (DC). Increasing evidence has revealed a connection between thyroid hormone (TH) and HCC, although this relationship remains contentious. Complements and immunoglobulin (Ig), which serve as surrogates of cirrhosis-associated immune dysfunction, are associated with the severity and outcomes of liver cirrhosis (LC). To date, there is a lack of evidence supporting the recommendation of TH, Ig, and complement tests in patients at high risk of HCC.

AIM

To assess the predictive value of TH, Ig, and complements for HCC development.

METHODS

Data from 142 patients, comprising 72 patients with CC and 70 patients with DC, were analysed as a training set. Among them, 100 patients who underwent complement and Ig tests were considered for internal validation. Logistic regression was employed to identify independent risk factors for HCC development.

RESULTS

The median follow-up duration was 32 (24-37 months) months. The incidence of HCC was significantly higher in the DC group (16/70, 22.9%) compared to the CC group (3/72, 4.2%) (χ² = 10.698, P < 0.01). Patients with DC exhibited lower total tetraiodothyronine (TT4), total triiodothyronine (TT3), free triiodothyronine, complement C3, and C4 (all P < 0.01), and higher IgA and IgG (both P < 0.01). In both CC and DC patients, TT3 and TT4 positively correlated with alanine transaminase (ALT), aspartate transaminase (AST), and gamma-glutamyl transpeptidase (GGT). IgG positively correlated with IgM, IgA, ALT, and AST, while it negatively correlated with C3 and C4. Multivariable analysis indicated that age, DC status, and GGT were independent risk factors for HCC development.

CONCLUSION

The predictive value of TH, Ig, and complements for HCC development is suboptimal. Age, DC, and GGT emerge as more significant factors during HCC surveillance in hepatitis B virus-related LC.

Keywords: Thyroid hormone; Immunoglobulin; Complement; Hepatocellular carcinoma; Prediction

Core Tip: Hepatocellular carcinoma (HCC) surveillance is crucial for patients with compensated cirrhosis (CC) and decompensated cirrhosis (DC). During a median follow-up duration of 32 months, the incidence of HCC was significantly higher in the DC group compared to the CC group. Total triiodothyronine and total tetraiodothyronine positively correlated with alanine transaminase (ALT), aspartate transaminase (AST), and gamma-glutamyl transpeptidase (GGT). Immunoglobulin (Ig) G positively correlated with IgM, IgA, ALT, and AST, while it negatively correlated with C3 and C4. The predictive value of thyroid hormone, Ig, and complements for HCC development is suboptimal. Multivariable analysis indicated that age, DC, and GGT were independent risk factors for HCC development.