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: Lymphocytes were reported to play a significant part in host anticancer immune responses and influence tumour prognosis. Few studies have focused on the prognostic values of aspartate aminotransferase (AST) to lymphocyte ratio (ALRI), aspartate aminotransferase to platelet count ratio index (APRI) and systemic immune-inflammation index (SII) in hepatocellular carcinoma (HCC) treated with palliative treatments. : Five hundred and ninety-eight HCC patients treated with palliative therapies were retrospectively analysed. We randomly assigned patients into the training cohort (429 patients) and the validation cohort I (169 patients). Receiver operating characteristic (ROC) curves were used to identify the best cut-off values for the ALRI, APRI and SII in the training cohort and the values were further validated in the validation cohort I. Correlations between ALRI and other clinicopathological factors were also analysed. A prognostic nomogram including ALRI was established. We validated the prognostic value of the ALRI, SII and APRI with two independent cohorts, the validation cohort II of 82 HCC patients treated with TACE and the validation cohort III of 150 HCC patients treated with curative resection. In the training cohort and all the validation cohorts, univariate analyses by the method of Kaplan-Meier and multivariate analysis by Cox proportional hazards regression model were carried out to identify the independent prognostic factors. : The threshold values of ALRI, APRI and SII were 86.3, 1.37 and 376.4 respectively identified by ROC curve analysis in the training cohort. Correlation analysis showed that ALRI>86.3 was greatly associated with higher rates of Child-Pugh B&C, portal vein tumor thrombosis (PVTT) and ascites ( 0.05). Correspondingly, ALRI level of HCC patients with Child-Pugh B&C, PVTT and ascites was evidently higher than that of HCC patients with Child-Pugh A, without PVTT and without ascites ( 0.001). In the training cohort and the validation cohort I, II, III, the OS of patients with ALRI >86.3 was obviously shorter than patients with ALRI ≤86.3 (0.001). We identified ALRI as an independent prognostic factor by univariate and multivariate analyses both in training Cohort (HR=1.481, 0.004), validation cohort I (HR=1.511, 0.032), validation cohort II (HR=3.166, 0.005) and validation cohort III (HR=3.921, 0.010). The SII was identified as an independent prognostic factor in training cohort (HR=1.356, 0.020) and the validation cohort II (HR=2.678, 0.002). The prognostic nomogram including ALRI was the best in predicting 3-month, 6-month, 1-year, 2-year survival And OS among TNM, ALRI, ALRI-TNM and nomogram. : The ALRI was a novel independent prognostic index for the HCC patients treated with palliative treatments.

据报道，淋巴细胞在宿主抗癌免疫反应中发挥重要作用，并影响肿瘤预后。很少有研究关注天冬氨酸转氨酶（AST）与淋巴细胞比值（ALRI）、天冬氨酸转氨酶与血小板计数比值指数（APRI）以及全身免疫炎症指数（SII）在接受姑息治疗的肝细胞癌（HCC）中的预后价值。

对598例接受姑息治疗的HCC患者进行回顾性分析。我们将患者随机分为训练队列（429例患者）和验证队列I（169例患者）。采用受试者工作特征（ROC）曲线确定训练队列中ALRI、APRI和SII的最佳截断值，并在验证队列I中进一步验证这些值。还分析了ALRI与其他临床病理因素之间的相关性。建立了包含ALRI的预后列线图。我们用两个独立队列验证了ALRI、SII和APRI的预后价值，即82例接受经动脉化疗栓塞（TACE）治疗HCC患者的验证队列II和150例接受根治性切除治疗HCC患者的验证队列III。在训练队列和所有验证队列中，采用Kaplan-Meier法进行单因素分析，采用Cox比例风险回归模型进行多因素分析，以确定独立的预后因素。

通过训练队列中的ROC曲线分析，确定ALRI、APRI和SII的阈值分别为86.3、1.37和376.4。相关性分析表明，ALRI>86.3与Child-Pugh B&C级、门静脉癌栓（PVTT）和腹水的发生率较高显著相关（P<0.05）。相应地，Child-Pugh B&C级、有PVTT和有腹水的HCC患者的ALRI水平明显高于Child-Pugh A级、无PVTT和无腹水的HCC患者（P<0.001）。在训练队列以及验证队列I、II和III中，ALRI>86.3的患者的总生存期（OS）明显短于ALRI≤86.3的患者（P<0.001）。通过单因素和多因素分析，我们在训练队列（HR=1.481，P=0.004）、验证队列I（HR=1.511，P=0.032）、验证队列II（HR=3.166，P=0.005）和验证队列III（HR=3.921，P=0.010）中均将ALRI确定为独立的预后因素。SII在训练队列（HR=1.356，P=0.020）和验证队列II（HR=2.678，P=0.002）中被确定为独立的预后因素。在预测3个月、6个月、1年、2年生存率以及总生存期方面，包含ALRI的预后列线图在TNM、ALRI、ALRI-TNM和列线图中表现最佳。

对于接受姑息治疗的HCC患者，ALRI是一个新的独立预后指标。