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ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 1
Jan.  2023
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Article Navigation >  Journal of Clinical Hepatology  > 2023  >  39(1): 118-127

Predictive value of preoperative alkaline phosphatase to prealbumin ratio in prognosis and postoperative complications in patients with hepatocellular carcinoma after radical tumor resection

DOI: 10.3969/j.issn.1001-5256.2023.01.018

  • Department of General Surgery (Hepatobiliary), the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China

Research funding:

Luzhou Municipal People's Government-Southwest Medical University Science and Technology Strategic Cooperation Projects (2018LZXNYD-ZK15)

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  • Corresponding author: LI Qiu, 354145933@qq.com (ORCID: 0000-0001-5259-6449)
  • Received Date: 2022-06-18
  • Accepted Date: 2022-08-22
  • Published Date: 2023-01-20
    Abstract
  •   Objective  To explore the predictive value of preoperative alkaline phosphatase to prealbumin ratio (APR) in prognosis and postoperative complications for patients with hepatocellular carcinoma (HCC) after radical tumor resection.  Methods  A total of 217 HCC patients who underwent radical tumor resection in the Department of Hepatobiliary Surgery of the Affiliated Hospital of Southwest Medical University from January 2013 to August 2021 were retrospectively recruited and their clinical data were statistically analyzed. The X-tile software was used to obtain the optimal cutoff value of APR. The χ2 test was conducted to analyze association between preoperative APR and other clinicopathological characteristics. The Kaplan-Meier curve was plotted and the Log-rank test was performed to analyze survival of patients. The univariate and multivariate Cox proportional hazards regression models were used to analysis factors affecting the prognosis of HCC patients. The univariate analysis and multivariate Logistic regression were used to identify factors related with postoperative complications. The receiver operating characteristic (ROC) curve was used to determine the predicting value of APR.  Results  The optimal cutoff value for APR ratio was 0.5 and these 217 patients were divided into the low- and high APR groups (111 vs 106 cases) accordingly. Compared with the low-APR group, the proportion of patients with ALT (> 50 U/L), Alb (< 40 g/L), the CNLC of the III stage, open surgery, liver cirrhosis, multiple tumor lesions, postoperative complication, and major complication were significantly increased in the high-APR patients (all P < 0.05). Moreover, the 1-, 3-, and 5-year OS were 86.0%, 74.9%, and 71.3%, respectively in the low-APR patients, while the numbers were 79.2%, 57.5%, and 47.0%, respectively, in the high-APR patients, indicating that patients in high-APR group had significantly worse OS (P=0.002). AFP (HR=1.774, 95%CI: 1.107-2.843, P=0.017), CNLC stage (HR=2.708, 95%CI: 1.514-4.844, P=0.001), tumor size (HR=1.696, 95%CI: 1.060-2.714, P=0.028), and APR (HR=2.022, 95%CI: 1.244-3.285, P=0.004) were all independent risk predictors for OS. The 1-, 3-, and 5-year RFS were 82.3%, 69.4%, and 61.3%, respectively, in the low-APR patients, whereas the numbers were 76.2%, 54.4%, and 44.2%, respectively in the high-APR patients, suggesting that high-APR patients had significantly worse recurrence-free survival (P=0.016). The CNLC stage (HR=2.509, 95%CI: 1.423-4.422, P=0.001), tumor size (HR=1.725, 95%CI: 1.119-2.660, P=0.014), and APR (HR=1.619: 95%CI: 1.037-2.527, P=0.034) were all independent FRS predictors. Hypertension (OR=3.09, 95%CI: 1.385-6.893, P=0.006), open surgery (OR=4.198, 95%CI: 1.779-9.907, P=0.001), liver cirrhosis (OR=2.376, 95%CI: 1.194-4.729, P=0.014), and APR (OR=2.151, 95%CI: 1.160-3.986, P=0.015) were all independent risk predictors for the postoperative major complications. The AUC for APR, ALP, a nd PA in predicting the major complications was 0.625 (95%CI: 0.547-0.702), 0.613 (95%CI: 0.534-0.693), and 0.554 (0.474-0.634).  Conclusion  Preoperative APR could be used to predict prognosis and postoperative major complications of HCC patients after radical tumor resection.

     

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    • References(39)
  • [1]
    BRAY F, FERLAY J, SOERJOMATARAM I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424. DOI: 10.3322/caac.21492.
    [2]
    ZHOU M, WANG H, ZENG X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2019, 394(10204): 1145-1158. DOI: 10.1016/S0140-6736(19)30427-1.
    [3]
    CHEN W, ZHENG R, BAADE PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132. DOI: 10.3322/caac.21338.
    [4]
    General Office of National Health Commission. Standard for diagnosis and treatment of primary liver cancer (2022 edition)[J]. J Clin Hepatol, 2022, 38(2): 288-303. DOI: 10.3969/j.issn.1001-5256.2022.02.009.

    国家卫生健康委办公厅. 原发性肝癌诊疗指南(2022年版)[J]. 临床肝胆病杂志, 2022, 38(2): 288-303. DOI: 10.3969/j.issn.1001-5256.2022.02.009.
    [5]
    XU XF, XING H, HAN J, et al. Risk factors, patterns, and outcomes of late recurrence after liver resection for hepatocellular carcinoma: a multicenter study from China[J]. JAMA Surg, 2019, 154(3): 209-217. DOI: 10.1001/jamasurg.2018.4334.
    [6]
    DHIR M, MELIN AA, DOUAIHER J, et al. A review and update of treatment options and controversies in the management of hepatocellular carcinoma[J]. Ann Surg, 2016, 263(6): 1112-1125. DOI: 10.1097/SLA.0000000000001556.
    [7]
    AMISAKI M, SAITO H, TOKUYASU N, et al. Prognostic value of postoperative complication for early recurrence after curative resection of hepatocellular carcinoma[J]. Hepatobiliary Pancreat Dis Int, 2018, 17(4): 323-329. DOI: 10.1016/j.hbpd.2018.03.016.
    [8]
    YANG T, ZHANG J, LU JH, et al. Risk factors influencing postoperative outcomes of major hepatic resection of hepatocellular carcinoma for patients with underlying liver diseases[J]. World J Surg, 2011, 35(9): 2073-2082. DOI: 10.1007/s00268-011-1161-0.
    [9]
    CHOK KS, NG KK, POON RT, et al. Impact of postoperative complications on long-term outcome of curative resection for hepatocellular carcinoma[J]. Br J Surg, 2009, 96(1): 81-87. DOI: 10.1002/bjs.6358.
    [10]
    HARIMOTO N, SHIRABE K, IKEGAMI T, et al. Postoperative complications are predictive of poor prognosis in hepatocellular carcinoma[J]. J Surg Res, 2015, 199(2): 470-477. DOI: 10.1016/j.jss.2015.06.012.
    [11]
    THELEN A, BENCKERT C, TAUTENHAHN HM, et al. Liver resection for hepatocellular carcinoma in patients without cirrhosis[J]. Br J Surg, 2013, 100(1): 130-137. DOI: 10.1002/bjs.8962.
    [12]
    LI Y, WANG JS, GUO Y, et al. Use of the alkaline phosphatase to prealbumin ratio as an independent predictive factor for the prognosis of gastric cancer[J]. World J Gastroenterol, 2020, 26(44): 6963-6978. DOI: 10.3748/wjg.v26.i44.6963.
    [13]
    RAHBARI NN, GARDEN OJ, PADBURY R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS)[J]. Surgery, 2011, 149(5): 713-724. DOI: 10.1016/j.surg.2010.10.001.
    [14]
    DINDO D, DEMARTINES N, CLAVIEN PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey[J]. Ann Surg, 2004, 240(2): 205-213. DOI: 10.1097/01.sla.0000133083.54934.ae.
    [15]
    CLAVIEN PA, BARKUN J, de OLIVEIRA ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience[J]. Ann Surg, 2009, 250(2): 187-196. DOI: 10.1097/SLA.0b013e3181b13ca2.
    [16]
    HAARHAUS M, BRANDENBURG V, KALANTAR-ZADEH K, et al. Alkaline phosphatase: a novel treatment target for cardiovascular disease in CKD[J]. Nat Rev Nephrol, 2017, 13(7): 429-442. DOI: 10.1038/nrneph.2017.60.
    [17]
    PARK JB, KANG DY, YANG HM, et al. Serum alkaline phosphatase is a predictor of mortality, myocardial infarction, or stent thrombosis after implantation of coronary drug- eluting stent[J]. Eur Heart J, 2013, 34(12): 920-931. DOI: 10.1093/eurheartj/ehs419.
    [18]
    LI JP, XU T, YANG FC, et al. Prognostic value of APAR for patients with hepatocellular carcinoma after radical hepatectomy[J/CD]. Chin J Hepat Surg(Electronic Edition), 2021, 10(3): 279-284. DOI: 10.3877/cma.j.issn.2095-3232.2021.03.010.

    李蒋鹏, 徐婷, 杨发才, 等. APAR对肝细胞癌根治性切除术后患者预后的预测价值[J/CD]. 中华肝脏外科手术学电子杂志, 2021, 10(3): 279-284. DOI: 10.3877/cma.j.issn.2095-3232.2021.03.010.
    [19]
    BARGER A, BAKER K, DRISKELL E, et al. The use of alkaline phosphatase and runx2 to distinguish osteosarcoma from other common malignant primary bone tumors in dogs[J]. Vet Pathol, 2022, 59(3): 427-432. DOI: 10.1177/03009858221083035.
    [20]
    YANG Y, ZHANG M, ZHANG W, et al. Sensitive sensing of alkaline phosphatase and γ-glutamyltranspeptidase activity for tumor imaging[J]. Analyst, 2022, 147(8): 1544-1550. DOI: 10.1039/d2an00163b.
    [21]
    XIA F, NDHLOVU E, LIU Z, et al. Alpha-fetoprotein+alkaline phosphatase (A-A) score can predict the prognosis of patients with ruptured hepatocellular carcinoma underwent hepatectomy[J]. Dis Markers, 2022, 2022: 9934189. DOI: 10.1155/2022/9934189.
    [22]
    ZHANG K, DONG S, JING YH, et al. Albumin-to-alkaline phosphatase ratio serves as a prognostic indicator in unresectable pancreatic ductal adenocarcinoma: a propensity score matching analysis[J]. BMC Cancer, 2020, 20(1): 541. DOI: 10.1186/s12885-020-07023-9.
    [23]
    ZHOU S, JIANG W, WANG H, et al. Predictive value of pretreatment albumin-to-alkaline phosphatase ratio for overall survival for patients with advanced non-small cell lung cancer[J]. Cancer Med, 2020, 9(17): 6268-6280. DOI: 10.1002/cam4.3244.
    [24]
    CHEN XY, LAN M, ZHOU Y, et al. Risk factors for bone metastasis from renal cell cancer[J]. J Bone Oncol, 2017, 9: 29-33. DOI: 10.1016/j.jbo.2017.10.004.
    [25]
    SMITH SH. Using albumin and prealbumin to assess nutritional status[J]. Nursing, 2017, 47(4): 65-66. DOI: 10.1097/01.NURSE.0000511805.83334.df.
    [26]
    DELLIÈRE S, CYNOBER L. Is transthyretin a good marker of nutritional status?[J]. Clin Nutr, 2017, 36(2): 364-370. DOI: 10.1016/j.clnu.2016.06.004.
    [27]
    BECK FK, ROSENTHAL TC. Prealbumin: a marker for nutritional evaluation[J]. Am Fam Physician, 2002, 65(8): 1575-1578.
    [28]
    SHEN Z, ZHANG J, ZHAO S, et al. Preoperative biliary drainage of severely obstructive jaundiced patients decreases overall postoperative complications after pancreaticoduodenectomy: A retrospective and propensity score- matched analysis[J]. Pancreatology, 2020, 20(3): 529-536. DOI: 10.1016/j.pan.2020.02.002.
    [29]
    LOFTUS TJ, BROWN MP, SLISH JH, et al. Serum levels of prealbumin and albumin for preoperative risk stratification[J]. Nutr Clin Pract, 2019, 34(3): 340-348. DOI: 10.1002/ncp.10271.
    [30]
    HUANG L, LI J, YAN JJ, et al. Prealbumin is predictive for postoperative liver insufficiency in patients undergoing liver resection[J]. World J Gastroenterol, 2012, 18(47): 7021-7025. DOI: 10.3748/wjg.v18.i47.7021.
    [31]
    LI JD, XU XF, HAN J, et al. Preoperative prealbumin level as an independent predictor of long-term prognosis after liver resection for hepatocellular carcinoma: a multi-institutional study[J]. HPB (Oxford), 2019, 21(2): 157-166. DOI: 10.1016/j.hpb.2018.06.1803.
    [32]
    CHRYSOSTOMOU S, STATHAKIS C, PETRIKKOS G, et al. Assessment of prealbumin in hemodialysis and renal-transplant patients[J]. J Ren Nutr, 2010, 20(1): 44-51. DOI: 10.1053/j.jrn.2009.04.001.
    [33]
    LIU F, CAI LY, ZHONG L, et al. Model for end-stage liver disease combined with serum prealbumin to predict the prognosis of patients with decompensated liver cirrhosis[J]. J Dig Dis, 2010, 11(6): 352-357. DOI: 10.1111/j.1751-2980.2010.00465.x.
    [34]
    ROCHE M, LAW TY, KUROWICKI J, et al. Albumin, prealbumin, and transferrin may be predictive of wound complications following total knee arthroplasty[J]. J Knee Surg, 2018, 31(10): 946-951. DOI: 10.1055/s-0038-1672122.
    [35]
    KALANTAR-ZADEH K, ANKER SD, HORWICH TB, et al. Nutritional and anti-inflammatory interventions in chronic heart failure[J]. Am J Cardiol, 2008, 101(11A): 89E-103E. DOI: 10.1016/j.amjcard.2008.03.007.
    [36]
    WEN X, YAO M, LU Y, et al. Integration of prealbumin into Child-Pugh classification improves prognosis predicting accuracy in HCC patients considering curative surgery[J]. J Clin Transl Hepatol, 2018, 6(4): 377-384. DOI: 10.14218/JCTH.2018.00004.
    [37]
    JIA RR, ZHONG JH, HUO RR, et al. Correlation between serum prealbumin and prognosis of patients with hepatocellular carcinoma after hepatectomy[J]. J Surg Oncol, 2019, 119(6): 794-800. DOI: 10.1002/jso.25378.
    [38]
    LI CX, ZHANG H, WU XF, et al. Clinical efficacy and prognostic factors analysis following curative hepatectomy for hepatocellular carcinoma patients with different China Liver Cancer Staging[J]. Chin J Surg, 2021, 59(2): 134-143. DOI: 10.3760/cma.j.cn112139-20200803-00605.

    李长贤, 张慧, 吴晓峰, 等. 不同中国肝癌分期肝癌根治性切除术后的临床效果及预后因素分析[J]. 中华外科杂志, 2021, 59(2): 134-143. DOI: 10.3760/cma.j.cn112139-20200803-00605.
    [39]
    KIM JH, KIM JW, SEO JW, et al. Noninvasive tests for fibrosis predict 5-year mortality and hepatocellular carcinoma in patients with chronic hepatitis B[J]. J Clin Gastroenterol, 2016, 50(10): 882-888. DOI: 10.1097/MCG.0000000000000574.
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