Albumin-to-alkaline phosphatase ratio as a predictor of tumor recurrence and prognosis in patients with early-stage hepatocellular carcinoma undergoing radiofrequency ablation as initial therapy

Zhang, Feng; Lu, Shenxin; Hu, Keshu; Gan, Yuhong; Chen, Yi; Ge, Ning-lin; Yang, Biwei; Zhang, Lan; Chen, Rongxin; Ren, Zhenggang; Yin, Xin

doi:10.1080/02656736.2020.1850885

Cited by 22 publications

(22 citation statements)

References 36 publications

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“…A meta-analysis conducted by Tian et al evaluated the possible utility of AAPR in solid cancers, and showed that low pretreatment AAPR was associated with worse OS in solid cancers, such as lung cancer, hepatocellular carcinoma, pancreatic ductal adenocarcinoma, and nasopharyngeal carcinoma 23 . Burgeoning evidences suggested the important prognostic value of AAPR 20 , 21 , 39 , 40 , which were consistent with our findings.…”

Section: Discussionsupporting

confidence: 92%

Prognostic role of pretreatment albumin-to-alkaline phosphatase ratio in locally advanced laryngeal and hypopharyngeal cancer: Retrospective cohort study

You

Jiang

et al. 2021

J. Cancer

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Background: This study was designed to assess the prognostic significance of pretreatment albumin-toalkaline phosphatase ratio (AAPR) in locally advanced laryngeal and hypopharyngeal cancer (LA-LHC). Materials and Methods:The clinical data of 341 patients with locally advanced laryngeal and hypopharyngeal cancer diagnosed between March 2007 and December 2018 were retrospectively collected and analyzed. The optimal cut-off value of AAPR for evaluating DFS was determined using the ROC curve, and 0.4912 was selected. Based on pretreatment AAPR values, patients were divided into two groups (low vs. high AAPR). Survival analysis was used to investigate the survival distribution between the groups. Univariate and multivariate analyses were performed to evaluate the prognostic value of AAPR. Based on the results of the multivariate analysis, we further developed models of DFS and OS. We assigned low AAPR, N1-3, age ≥65 years, and positive vascular invasion one score, respectively. Results: Survival analysis demonstrated that the survival of patients with low and high AAPR was significantly different (low vs. high AAPR: 5-year DFS, 46.0 vs. 71.9%, p<0.001; 5-year OS, 69.0 vs. 72.6%, p<0.001). Univariate and multivariate analyses further showed that pretreatment AAPR served as an independent indicator in LA-LHC. Moreover, survival analysis showed that patients with high model score had poorer DFS and OS (5-year DFS: 58.1, 42.7, 26.9 and 9.1% of score zero, one, two, and three respectively, p<0.001; 5-year OS: 63.0, 50.3, 34.1 and 28.6% of score zero, one, two, and three respectively, p<0.001). Conclusion: Pretreatment AAPR could be an independent prognostic indicator in patients with LA-LHC. Incorporating AAPR into the risk stratification model might better categorize patients with worse oncological outcomes and support treatment strategy making.

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Section: Discussionsupporting

confidence: 92%

Prognostic role of pretreatment albumin-to-alkaline phosphatase ratio in locally advanced laryngeal and hypopharyngeal cancer: Retrospective cohort study

You

Jiang

et al. 2021

J. Cancer

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“…Conversely, the potential and power of radiological image data, which include CT, MRI, PET, and ultrasound, are increasingly recognized in the field of oncology[ 16 - 19 ]. Meanwhile, serology indicators, such as albumin-to-alkaline phosphatase ratio[ 7 ], AFP[ 20 ], and neutrophil–lymphocyte ratio[ 21 ], are also widely used in this domain. In our study, parameters that may predict recurrence pre-operation were collected, rigorous statistical analysis was performed, and unimportant parameters were excluded.…”

Section: Discussionmentioning

confidence: 99%

“…With the development of radiology technology and serology detection ability, predicting postoperative recurrence noninvasively is possible. Many scholars have used radiology technology or serological biomarkers to achieve this goal[ 7 , 8 ], but only a few have combined the two technologies; the combination of ultrasound and serological biomarkers has not been used for preoperative prediction. Ultrasound examination is favored by clinicians and patients for its lack of radiation, repeatability, and real-time monitoring.…”

Section: Introductionmentioning

confidence: 99%

Novel model combining contrast-enhanced ultrasound with serology predicts hepatocellular carcinoma recurrence after hepatectomy

Tu¹,

Huang²,

Feng³

et al. 2021

WJCC

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BACKGROUND Surgery is the primary curative option in patients with hepatocellular carcinoma (HCC). However, recurrence within 2 years is observed in 30%–50% of patients, being a major cause of mortality. AIM To construct and verify a non-invasive prediction model combining contrast-enhanced ultrasound (CEUS) with serology biomarkers to predict the early recurrence of HCC. METHODS Records of 744 consecutive patients undergoing first-line curative surgery for HCC in one institution from 2016–2018 were reviewed, and 292 local patients were selected for analysis. General characteristics including gender and age, CEUS liver imaging reporting and data system (LIRADS) parameters including wash-in time, wash-in type, wash-out time, and wash-out type, and serology biomarkers including alanine aminotransferase, aspartate aminotransferase, platelets, and alpha-fetoprotein (AFP) were collected. Univariate analysis and multivariate Cox proportional hazards regression model were used to evaluate the independent prognostic factors for tumor recurrence. Then a nomogram called CEUS model was constructed. The CEUS model was then used to predict recurrence at 6 mo, 12 mo, and 24 mo, the cut-off value was calculate by X-tile, and each C-index was calculated. Then Kaplan-Meier curve was compared by log-rank test. The calibration curves of each time were depicted. RESULTS A nomogram predicting early recurrence (ER), named CEUS model, was formulated based on the results of the multivariate Cox regression analysis. This nomogram incorporated tumor diameter, preoperative AFP level, and LIRADS, and the hazard ratio was 1.123 (95% confidence interval [CI]: 1.041-1.211), 1.547 (95%CI: 1.245-1.922), and 1.428 (95%CI: 1.059-1.925), respectively. The cut-off value at 6 mo, 12 mo, and 24 mo was 100, 80, and 50, and the C-index was 0.748 (95%CI: 0.683-0.813), 0.762 (95%CI: 0.704-0.820), and 0.762 (95%CI: 0.706-0.819), respectively. The model showed satisfactory results, and the calibration at 6 mo was desirable; however, the calibration at 12 and 24 mo should be improved. CONCLUSION The CEUS model enables the well-calibrated individualized prediction of ER before surgery and may represent a novel tool for biomarker research and individual counseling.

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“…The albumin-to-alkaline phosphatase ratio (AAPR), a novel non-invasive indicator based on serum albumin (ALB) and alkaline phosphatase (ALP), was rstly investigated to be associated with prognosis in HCC patients in 2015 [5]. Since then, a series of studies have attempted to explore the value of AAPR as a prognostic marker in HCC [6,7,8,9,10,11]. Due to the small sample sizes, variable qualities and inconsistent results of previous studies, a systematic summary analysis is required.…”

Section: Introductionmentioning

confidence: 99%

Prognostic effect of albumin-to-alkaline phosphatase ratio on patients with hepatocellular carcinoma: a systematic review and meta-analysis.

Zhang

Xin

et al. 2022

Preprint

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Background The prognostic value of albumin-to-alkaline phosphatase ratio (AAPR) in patients with hepatocellular carcinoma (HCC) remains controversial. This meta-analysis aims to evaluate the prognostic role of AAPR in patients with HCC. Methods The databases of Web of Science, Embase, Cochrane Library and PubMed were comprehensively searched from inception to April 25, 2022. Pooled hazard ratio (HR) and 95% confidence interval (CI) were calculated with Stata 16.0 software for the assessment of the relationship between AAPR and overall survival (OS) as well as disease-free survival (DFS) in patients with HCC. Results A total of 2634 patients from 12 cohorts were included in this meta-analysis. The pooled results showed that lower AAPR was significantly associated with poorer OS (HR: 2.02, 95% CI: 1.78–2.30). Similarly, pooled results demonstrated that lower AAPR was also significantly associated with poorer DFS (HR: 1.61, 95% CI: 1.36–1.92). Heterogeneity for DFS and publication bias for OS existed, however, the subgroup analysis, meta-regression analysis as well as adjustment using trim-and-fill analysis confirmed a stable interaction between AAPR and OS as well as DFS. Conclusions This meta-analysis proves that lower AAPR was significantly associated with poorer OS and DFS in patients with HCC, and AAPR could be a promising indicator for prognosis of HCC.

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Albumin-to-alkaline phosphatase ratio as a predictor of tumor recurrence and prognosis in patients with early-stage hepatocellular carcinoma undergoing radiofrequency ablation as initial therapy

Cited by 22 publications

References 36 publications

Prognostic role of pretreatment albumin-to-alkaline phosphatase ratio in locally advanced laryngeal and hypopharyngeal cancer: Retrospective cohort study

Prognostic role of pretreatment albumin-to-alkaline phosphatase ratio in locally advanced laryngeal and hypopharyngeal cancer: Retrospective cohort study

Novel model combining contrast-enhanced ultrasound with serology predicts hepatocellular carcinoma recurrence after hepatectomy

Prognostic effect of albumin-to-alkaline phosphatase ratio on patients with hepatocellular carcinoma: a systematic review and meta-analysis.

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