Albumin-to-Alkaline Phosphatase Ratio: A Novel Prognostic Index for Hepatocellular Carcinoma

Abstract EN

Prognosis of patients with hepatocellular carcinoma (HCC) depends on both tumour extent and hepatic function reserve.

Liver function test (LFT) is a basic routine blood test to evaluate hepatic function.

We first analysed LFT components and their associated scores in a training cohort of 217 patients who underwent curative surgery to identify LFT parameters with high performance (discriminatory capacity, homogeneity, and monotonicity of gradient).

We derived a novel index, albumin-to-alkaline phosphatase ratio (AAPR), which had the highest c-index (0.646) and χ2 (24.774) among other liver biochemical parameters.

The AAPR was an independent prognostic factor for overall and disease-free survival.

The adjusted hazard ratio of death and tumour relapse was 2.36 (P=0.002) and 1.85 (P=0.010), respectively.

The independent prognostic significance of AAPR on top of 5 commonly used and well established staging systems was further confirmed in 2 independent cohorts of patients receiving surgical resection (n=256) and palliative therapy (n=425).

In summary, the AAPR is a novel index readily derived from a simple low-cost routine blood test and is an independent prognostic indicator for patients with HCC regardless of treatment options.