Low serum creatine kinase level is associated with poor prognosis in patients with hepatocellular carcinoma: A retrospective single‑center study

Abstract

Previous studies have reported low serum creatine kinase (s-CK) levels as a poor prognostic factor in various cancers. However, there have been no reports on its significance in hepatocellular carcinoma. The present study aimed to evaluate the association of the preoperative s-CK levels with clinicopathologic features and their prognostic impact on survival in patients with hepatocellular carcinoma. This retrospective study included 163 patients with hepatocellular carcinoma (127 male and 36 female patients; median age, 69 years) who underwent radical liver resection between January 2004 and December 2021. A cutoff preoperative s-CK level of 91 U/l determined by receiver operating characteristic curve analysis was used to evaluate the significance of s-CK in predicting overall and recurrence-free survival. In addition, the prognostic impact of s-CK was evaluated using univariate and multivariate analysis. s-CK level was not associated with clinicopathologic factors. Overall survival and recurrence-free survival of the low s-CK group were significantly worse compared with the high s-CK group (P=0.043 and P=0.029, respectively). By multivariate analysis, low s-CK was an independent risk factor for poor overall survival and recurrence-free survival (P=0.019 and P=0.014, respectively). This trend was the same for male patients, but no significant difference was observed for female patients. Low preoperative s-CK level might be a poor prognostic biomarker in patients with hepatocellular carcinoma.

Keywords: hepatocellular carcinoma; prognosis; serum creatine kinase.

Figure 1.

(A) Receiver operating characteristic curve predicting overall survival of all patients by preoperative s-CK and (B) a flow chart of patients analyzed in the study. AUC, the area under the curve; CI, confidence interval; CK, creatine kinase.

Figure 2.

Comparisons of overall survival curves between low s-CK group and high s-CK group for (A) all patients, (B) male patients and (C) female patients. Comparisons of recurrence-free survival curves between the low s-CK group and the high s-CK group for (D) all patients, (E) male patients and (F) female patients. s-CK, serum creatine kinase.

Figure 3.

Mechanism of regulations of s-CK in patients with HCC. (A) Details of factors that increase and decrease preoperative s-CK levels in patients with HCC. (B) Diagram of the balance of s-CK in the low and high preoperative s-CK groups. s-CK, serum creatine kinase; HCC, hepatocellular carcinoma.