The Predictive Value of Albumin-to-Alkaline Phosphatase Ratio for Overall Survival of Hepatocellular Carcinoma Patients Treated with Trans-Catheter Arterial Chemoembolization Therapy

Abstract

Background: We have previously reported the prognostic value of the albumin-to-alkaline phosphatase ratio (AAPR) for advanced hepatocellular carcinoma (HCC) patients who are not receiving any standard anticancer therapy. However, the prognostic value of the AAPR for HCC patients treated with trans-catheter arterial chemoembolization therapy (TACE) was not investigated.Methods: We retrospectively analysed 372 HCC patients treated with TACE (the training cohort) and applied receiver operating characteristic curves (ROC curves) to identify the best cut-off value for the AAPR in this cohort. Then, univariate analyses by the Kaplan-Meier method and multivariate analysis by a Cox proportional hazards regression model were conducted. Both comparisons of the ROC curves and the likelihood ratio test (LRT) were employed to evaluate the abilities of different factors in predicting the survival of patients in this cohort. Finally, the prognostic value of the AAPR was validated in two cohorts: one included 202 HCC patients treated with supportive care (validation cohort I), and the other included 82 HCC patients treated with TACE (validation cohort II).Results: We identified 0.439 as the best cut-off value of the AAPR by ROC curve analysis. An AAPR > 0.439 was significantly correlated with a lower frequency of Child-Pugh grade B, portal vein tumour thrombus (PVTT), T3-4 and lymph node metastasis (P < 0.05). The median overall survival (OS) of the patients with an AAPR > 0.439 was significantly longer than that of those with an AAPR ≤ 0.439 (58.4 m vs 17.8 m, respectively, P < 0.001). The AAPR was identified as an independent prognostic factor after univariate and multivariate analyses (HR = 0.636, P = 0.003). The independent prognostic value of the AAPR was also confirmed in validation cohorts I and II. Additionally, we substituted the AAPR for the Child-Pugh grade in the CLIP system and integrated the AAPR into the TNM system. We found that the area under the curve (AUC) of the AAPR-CLIP system was significantly larger than that of the CLIP and the TNM when predicting 3-month, 6-month, 1-year and 2-year survival (P < 0.05). There was no significant difference between the AUCs for the AAPR-CLIP and the AAPR-TNM. The LRT suggested that both AAPR-CLIP and AAPR-TNM had significantly larger χ2 values and smaller AIC values than that of their corresponding primary system (P < 0.05).Conclusions: The AAPR was an independent prognostic index for the HCC patients treated with TACE. Both AAPR-CLIP and AAPR-TNM outperformed their corresponding primary system in predicting OS in the current study.

Prognostic value of the albumin-to-alkaline phosphatase ratio on urologic outcomes in patients with non-metastatic renal cell carcinoma following curative nephrectomy

“…This cutoff value, 0.39 for AAPR, was suggested as a superior prognostic level according to HR. Nevertheless, the cutoff-point was not consistent with those from previous studies [15][16][17]27] and was close to that of one study [14]. This common problem can also be observed in studies of other prognostic biomarkers, including the platelet-lymphocyte ratio and neutrophil-lymphocyte ratio [31].…”

“…At the moment, some biomarkers from blood have been established, including the AST/ALT (De Ritis) ratio, the neutrophil-to-lymphocyte ratio, and the prognostic nutritional index [10][11][12], although their results remain inconsistent and controversial. Recently, the albumin-to-alkaline phosphate ratio (AAPR), a novel prognostic factor, has been demonstrated to be significantly associated with poorer urologic outcomes for hepatocellular carcinoma (HCC), metastatic nasopharyngeal carcinoma, and upper tract urothelial carcinoma (UTUC) [13][14][15][16][17]. However, it has not yet been studied in non-metastatic RCC patients following curative nephrectomy.…”

Predictive value of pretreatment albumin‐to‐alkaline phosphatase ratio for overall survival for patients with advanced non‐small cell lung cancer

“…13,14 Since Chan et al 15 firstly reported the ratio of ALB to ALP combined with ALB and ALP levels can be used as an indicator for predicting the prognosis for patients with liver cancer, and such prediction ability is higher than that based on ALB or ALP levels alone, more studies began to investigate these indicators in other types of cancer. [7][8][9][10][16][17][18][19][20][21] Li et al 16 firstly reported that the relationship between AAPR and OS after investigating 290 stage IV NSCLC patients, finding that AAPR was an independent predictor of OS in multivariate analysis (HR = 0.657, 95% CI = 0.504-0.856, P < .01). Different from their study, we conducted a larger respective cohort as well as included more important variables for analysis, such EGFR and ALK mutation status, ECOG-performance status, therapeutic regiment, F I G U R E 4 Forest plot for presenting the association between the hazard ratio of overall survival and medium AAPR in advanced NSCLC patients and organ metastasis parameters, which have been verified to exert influence on the clinical outcome of the NSCLC patients.…”

Prognostic Significance of Pretreatment Albumin to Alkaline Phosphatase Ratio in Human Cancers: A Meta-Analysis

“…In the current research, 15 retrospective articles with 6,062 cancer patients were included [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. Because of the subgroup analysis in three articles [15,17,19], we regarded them as 2 or 3 independent studies. The publication dated from 2015 to 2019, and the number of cancer patients ranged from 82 to 746.…”