Preoperative aspartate aminotransferase-to-platelet ratio index (APRI) is a predictor on postoperative outcomes of hepatocellular carcinoma

Cheng, Jiwen; Zhao, Pu; Liu, Jiangbo; Liu, Xi; Wu, XuanLin

doi:10.1097/md.0000000000005486

Cited by 30 publications

(37 citation statements)

References 25 publications

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“…It is reported that serum APRI could be used in evaluating the degree of fibrosis and liver function reserve, as well as predicting prognosis for patients with chronic hepatitis [12]. APRI is also a predictor for postoperative outcomes of HCC [13]. In HBV-related HCC, Huang et al had reported that serum APRI might be employed as a biomarker for assessing liver cirrhosis and predicting both recurrence and survival of the patients [14].…”

Section: Introductionmentioning

confidence: 99%

A novel prognostic score model based on combining systemic and hepatic inflammation markers in the prognosis of HBV-associated hepatocellular carcinoma patients

Zhang

Liu

Zhao

et al. 2019

Artificial Cells, Nanomedicine, and Biotechnology

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2019) A novel prognostic score model based on combining systemic and hepatic inflammation markers in the prognosis of HBV-associated hepatocellular carcinoma patients, Artificial Cells, Nanomedicine, and Biotechnology, 47:1, 2246-2255, ABSTRACTObjectives: The study aimed to evaluate the prognostic value of systemic inflammation markers [neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Prognostic Nutritional Index (PNI)] and hepatic inflammation markers [aspartate aminotransferase-to-platelet ratio index (APRI), c-glutamyl transferase (c-GT)/alanine aminotransferase (ALT)] in patients with hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC) and further to develop a novel prognostic score model. Methods: A total of 401 cases with HBV-associated HCC who underwent hepatectomy as initial therapy were included in the analysis. Kaplan-Meier was performed to construct survival curves and receiver operating characteristic (ROC) analysis was used to detect the optimal cut-off value of markers. The prognostic score model was constructed using significant inflammation markers in the Cox model. Each factor was given a score of 1 and patients were stratified according to the scores. Results: In the Cox model, a-fetoprotein (AFP), ALT, tumour differentiation, maximum size of tumours, TNM stage, PNI and c-GT/ALT were independently prognostic factors. We established a preoperative inflammation-based prognostic scoring model combining PNI and c-GT/ALT. The novel preoperative inflammation-based prognostic score was superior (area under the curve [AUC], 0.659) to 7 th tumournode-metastasis (TNM) stage (AUC, 0.600) despite no statistical significance (p ¼ .1036). Conclusion: PNI and c-GT/ALT are independent predictors for prognosis. The novel prognostic score model based on systemic and hepatic inflammation markers is suitable for the prognosis evaluation in patients with HBV-associated HCC.

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Section: Introductionmentioning

confidence: 99%

A novel prognostic score model based on combining systemic and hepatic inflammation markers in the prognosis of HBV-associated hepatocellular carcinoma patients

Zhang

Liu

Zhao

et al. 2019

Artificial Cells, Nanomedicine, and Biotechnology

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“…The APRI was introduced by Wai et al in 2003 as a predictive measure for fibrosis and cirrhosis in patients with chronic hepatitis 25 . Later, different studies concluded that its preoperative measures significantly predict post-hepatectomy morbidity and mortality [26][27][28] . Mai et al recently evaluated 1,044 hepatocellular carcinoma patients that underwent liver resection, and demonstrated that APRI could significantly predict post-hepatectomy outcomes (AUC = 0.743), in agreement with our results.…”

Section: Discussionmentioning

confidence: 99%

Comparative Analysis of the Discriminatory Performance of Different Well-Known Risk Assessment Scores for Extended Hepatectomy

Ghamarnejad

Khajeh

Rezaei

et al. 2020

Sci Rep

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The aim of this study was to assess and compare the discriminatory performance of well-known risk assessment scores in predicting mortality risk after extended hepatectomy (EH). A series of 250 patients who underwent EH (≥5 segments resection) were evaluated. Aspartate aminotransferase-to-platelet ratio index (APRI), albumin to bilirubin (ALBI) grade, predictive score developed by Breitenstein et al., liver fibrosis (FIB-4) index, and Heidelberg reference lines charting were used to compute cutoff values, and the sensitivity and specificity of each risk assessment score for predicting mortality were also calculated. Major morbidity and 90-day mortality after EH increased with increasing risk scores. APRI (86%), ALBI (86%), Heidelberg score (81%), and FIB-4 index (79%) had the highest sensitivity for 90-day mortality. However, only the FIB-4 index and Heidelberg score had an acceptable specificity (70% and 65%, respectively). A two-stage risk assessment strategy (Heidelberg-FIB-4 model) with a sensitivity of 70% and a specificity 86% for 90-day mortality was proposed. There is no single specific risk assessment score for patients who undergo EH. A two-stage screening strategy using Heidelberg score and FIB-4 index was proposed to predict mortality after major liver resection.

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“…Ichikawa et al (25) confirmed that preoperative APRI independently predicts postoperative liver failure. In addition, Cheng et al (11) suggested APRI could predict postoperative complications in HCC patients after liver resection. Further, some studies confirmed that postoperative complications may adversely influence both postoperative RFS and OS for patients with HCC after liver resection (26)(27)(28).…”

Section: Discussionmentioning

confidence: 99%

“…However, ALBI only reflects patient liver function and cannot indicate the degree of liver fibrosis in HCC patients. Preoperative aspartate aminotransferase (AST)-toplatelet count ratio index (APRI) has been confirmed as a surrogate marker for histological fibrogenesis (11). It is unclear whether ALBI incorporated with APRI results could strengthen the prognostic power for HCC patients within Milan criteria following liver resection.…”

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confidence: 99%

Preoperative albumin-bilirubin grade combined with aspartate aminotransferase-to-platelet count ratio index predict outcomes of patients with hepatocellular carcinoma within Milan criteria after liver resection

Luo

Chen

2019

BST

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Hepatocellular carcinoma (HCC) is one of the most common malignancies and is ranked the third most frequent cancer-related mortality worldwide (1). Every year, more than 800,000 new cases are diagnosed, and mortality is high due to the poor prognosis of HCC (2). Liver resection is widely accepted as a curative treatment for HCC patients with well-compensated liver function. However, the 5-year overall survival for HCC patients after liver resection remains unsatisfactory due to the high incidence of postoperative recurrence (3). Some investigations suggest as many as 51.6-70.3% of patients with HCC within Milan criteria will suffer from recurrence after liver resection (4,5). Liver function greatly influences the prognosis of HCC patients. Patients with poor liver function are at high risk for postoperative complications and tend to Summary There is little information concerning the prognostic significance of combined albuminbilirubin (ALBI) grade and aspartate aminotransferase-to-platelet count ratio index (APRI) in hepatocellular carcinoma (HCC). Therefore, we performed this study to assess the prognostic utility of combining ALBI and APRI (ALBI-APRI score) for predicting the prognosis of patients with HCC within Milan criteria after liver resection. Two hundred thirty-nine patients were involved in this study. Patients with a high APRI score were allocated a score of 1, whereas patients with a low APRI score were allocated a score of 0. The ALBI-APRI score is the summation of APRI score and ALBI grade. The area under the receiver operating characteristic curve (AUC) was used to estimate the predictive accuracy of different models. During the study period, 132 patients experienced recurrence, and 52 patients died. Multivariate analysis revealed the ALBI-APRI score (HR = 1.753, 95% CI = 1.293-2.377, p < 0.001), presence of microvascular invasion (MVI, HR = 2.693, 95%CI = 1.832-3.960, p < 0.001) and multiple tumors (HR = 1.973, 95% CI = 1.300-2.995, p = 0.001) were all associated with recurrence. In addition, blood transfusion (HR = 3.113, 95% CI = 1.677-5.778, p < 0.001), high preoperative alpha-fetoprotein (AFP, HR = 2.272, 95% CI = 1.298-3.976, p = 0.004), ALBI-APRI score (HR = 2.046, 95% CI = 1.237-3.382, p = 0.005) and presence of MVI (HR = 4.524, 95% CI = 2.514-8.140, p < 0.001) were correlated with postoperative mortality. The AUCs of ALBI-APRI score were significantly higher than either ALBI or APRI alone for predicting both postoperative recurrence and mortality. ALBI-APRI score may be a predictor for the prognosis of patients with HCC within Milan criteria following liver resection. A more well-designed and large-scale study are warranted to prove our findings.

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Preoperative aspartate aminotransferase-to-platelet ratio index (APRI) is a predictor on postoperative outcomes of hepatocellular carcinoma

Cited by 30 publications

References 25 publications

A novel prognostic score model based on combining systemic and hepatic inflammation markers in the prognosis of HBV-associated hepatocellular carcinoma patients

A novel prognostic score model based on combining systemic and hepatic inflammation markers in the prognosis of HBV-associated hepatocellular carcinoma patients

Comparative Analysis of the Discriminatory Performance of Different Well-Known Risk Assessment Scores for Extended Hepatectomy

Preoperative albumin-bilirubin grade combined with aspartate aminotransferase-to-platelet count ratio index predict outcomes of patients with hepatocellular carcinoma within Milan criteria after liver resection

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