Cai Xiurong, Chen Zhanhong, Chen Jie, Ma Xiaokun, Bai Mingjun, Wang Tiantian, Chen Xiangwei, Wu Donghao, Wei Li, Li Xing, Lin Qu, Wen Jingyun, Ruan Danyun, Lin Zexiao, Dong Min, Wu Xiangyuan
Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China.
Department of Medical Oncology of Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, People's Republic of China.
J Cancer. 2018 Jan 1;9(1):189-197. doi: 10.7150/jca.21799. eCollection 2018.
Albumin-to-Alkaline Phosphatase Ratio (ALB/ALP ratio, AAPR), a newly developed index of liver function, has been rarely discussed about its prognostic value in malignancies. The current study attempted to evaluate the prognostic prediction of AAPR in advanced HCC. 237 advanced HCC patients who refused any standard anti-cancer therapies were retrospectively analyzed. The threshold value of AAPR was determined by receiver operating characteristic (ROC) curve. Univariate analyses using Kaplan-Meier method and log-rank test, and multivariate analysis using Cox proportional hazards regression model were conducted. Comparisons of ROC curves and likelihood ratio test (LRT) were utilized to compare the value of different factors in predicting survival. ROC curve analysis confirmed 0.38 as the optimal cutoff value of AAPR in evaluating overall survival (OS). Patients with an AAPR > 0.38 exhibited significantly lower frequencies of ascites, portal vein tumor thrombus, Child-Pugh grade B & C, and KPS < 70 (all < 0.05). These patients also displayed a longer median survival time than those with an AAPR ≤ 0.38 (5.8 m vs 2.4 m, < 0.01). Univariate and multivariate analyses identified AAPR as an independent prognostic indicator ( = 0.592, = 0.007). Furthermore, we integrated AAPR with TNM system and found that area under curve of AAPR-TNM system was significantly larger than that of TNM system when predicting 3-month survival (0.670 vs 0.611, < 0.01). Moreover, LRT indicated that AAPR-TNM system had a significantly larger χ (26.4 vs 16.4, < 0.01) and a significantly smaller Akaike information criterion value (1936 vs 1948, < 0.01) comparing with TNM system. Our study implied that AAPR was a potentially valuable prognostic index for advanced HCC patients without receiving any standard anti-cancer therapies. AAPR-TNM system preceded TNM system in predicting overall survival in this study.
白蛋白与碱性磷酸酶比值（ALB/ALP比值，AAPR）是一种新开发的肝功能指标，其在恶性肿瘤中的预后价值鲜有讨论。本研究试图评估AAPR在晚期肝癌中的预后预测能力。对237例拒绝任何标准抗癌治疗的晚期肝癌患者进行了回顾性分析。AAPR的阈值通过受试者工作特征（ROC）曲线确定。采用Kaplan-Meier法和对数秩检验进行单因素分析，采用Cox比例风险回归模型进行多因素分析。利用ROC曲线比较和似然比检验（LRT）来比较不同因素在预测生存方面的价值。ROC曲线分析确定0.38为AAPR评估总生存期（OS）的最佳临界值。AAPR>0.38的患者腹水、门静脉癌栓、Child-Pugh B级和C级以及KPS<70的发生率显著较低（均<0.05）。这些患者的中位生存时间也比AAPR≤0.38的患者更长（5.8个月对2.4个月，<0.01）。单因素和多因素分析均将AAPR确定为独立的预后指标（=0.592，=0.007）。此外，我们将AAPR与TNM系统相结合，发现AAPR-TNM系统在预测3个月生存率时曲线下面积显著大于TNM系统（0.670对0.611，<0.01）。此外，LRT表明，与TNM系统相比，AAPR-TNM系统的χ值显著更大（26.4对16.4，<0.01），赤池信息准则值显著更小（1936对1948，<0.01）。我们的研究表明，AAPR对于未接受任何标准抗癌治疗的晚期肝癌患者是一个潜在有价值的预后指标。在本研究中，AAPR-TNM系统在预测总生存期方面优于TNM系统。
