Preoperative alkaline phosphatase-to-platelet count ratio as a prognostic factor for hepatocellular carcinoma with microvascular invasion

Yongxin Zhang; Bin Zhang; Lianggeng Gong; Liangxia Xiong; Xuehong Xiao; Chao Bu; Zhiying Liang; Liangcai Li; Binghang Tang; Yangbai Lu

doi:10.1002/cam4.6368

Preoperative alkaline phosphatase-to-platelet count ratio as a prognostic factor for hepatocellular carcinoma with microvascular invasion

Cancer Med. 2023 Sep;12(17):17545-17558. doi: 10.1002/cam4.6368. Epub 2023 Jul 26.

Authors

Yongxin Zhang¹, Bin Zhang², Lianggeng Gong³, Liangxia Xiong³, Xuehong Xiao¹, Chao Bu⁴, Zhiying Liang⁵, Liangcai Li⁶, Binghang Tang⁶, Yangbai Lu⁷

Affiliations

¹ Department of MR, Zhongshan City People's Hospital, Zhongshan, China.
² Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, China.
³ Department of Medical Imaging Center, The second affiliated Hospital of Nanchang University, Nanchang, China.
⁴ Department of Radiology, The Seventh Affiliated Hospital Sun Yat-Sen University, Shenzhen, China.
⁵ Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.
⁶ Department of CT, Zhongshan City People's Hospital, Zhongshan, China.
⁷ Department of Urology, Zhongshan City People's Hospital, Zhongshan, China.

Abstract

Objectives: The association between platelet status and hepatocellular carcinoma (HCC) prognoses remains controversial. Herein, we aimed to clarify the prognostic value of multiple platelet-related biomarkers, including platelet count, platelet/lymphocyte ratio (PLR), aspartate aminotransferase to platelet ratio index (APRI), and alkaline phosphatase-to-platelet count ratio index (APPRI) in HCC with microvascular invasion (MVI) after curative resection or liver transplantation.

Materials and methods: A retrospective review of 169 patients with solitary HCC and MVI who underwent resection or liver transplantation between January 2015 and December 2018 was conducted. Preoperative clinical, laboratory, pathologic, and imaging data were collected and analyzed. Overall survival (OS) and disease-free survival (DFS) were defined as the clinical endpoints. Univariate and multivariate Cox proportional hazards regression analyses were conducted to investigate potential predictors of DFS and OS.

Results: Multivariate Cox regression analyses revealed that maximum tumor diameter, poor cell differentiation, and APPRI were independent predictors of DFS; while poor cell differentiation, APRI, APPRI, prothrombin time, and alpha-fetoprotein were independent prognostic factors for OS. The 1-, 3-, and 5-year DFS rates were 66.90%, 48.40%, and 37.40% for patients with APPRI ≤0.74 and 40.40%, 24.20%,and 24.20% for patients with APPRI>0.74. The corresponding rates of OS over 1, 3, and 5 years were 92.40%, 88.10% and 77.70%, and 72.30%, 38.20%, and 19.10%, respectively. The DFS and OS rates of patients whose APPRI was more than 0.74 were substantially lower than those of patients whose APPRI was less than or equal to 0.74 (p = 0.002 and p < 0.001, respectively).

Conclusion: Elevated preoperative APPRI is a noninvasive, simple, and easily assessable parameter linked to poor prognosis in individuals with single HCC and MVI after resection or liver transplantation.

Keywords: aspartate aminotransferase to platelet ratio; disease-free survival; hepatocellular carcinoma; overall survival.

Abstract

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