Huang Jian, Yang Yun, Xia Yong, Liu Fu-Chen, Liu Lei, Zhu Peng, Yuan Sheng-Xian, Gu Fang-Ming, Fu Si-Yuan, Zhou Wei-Ping, Liu Hui, Jiang Bei-Ge, Pan Ze-Ya
The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University (Second Military Medical University), Shanghai, 201805, People's Republic of China.
Department of Medical Oncology, Shanghai Mengchao Cancer Hospital, Shanghai, 201805, People's Republic of China.
Cancer Manag Res. 2021 Feb 19;13:1733-1746. doi: 10.2147/CMAR.S284950. eCollection 2021.
To predict patient survival in early-stage hepatocellular carcinoma (HCC) following hepatic resection. We evaluated the prognostic potential of the aspartate aminotransferase to platelet ratio index (APRI) in order to use it to model a nomogram.
We randomized 901 early-stage HCC patients treated with hepatic resection at our center into training and validation cohorts that were followed from January 2009 to December 2012. X-tile software was used to establish the APRI cut-off threshold in the training cohort. The validation cohort was subsequently assessed to determine threshold value accuracy. Data generated from the multivariate analysis in the training cohort were used to design a prognostic nomogram. Decision curve analyses (DCA), concordance index values (C-index) and calibration curves were used to determine the performance of the nomogram.
X-tile software revealed that the optimal APRI cut-off threshold in the training cohort that distinguished between patients with different prognoses was 0.9. We, therefore, validated its prognostic value. Multivariate analyses showed that poor overall survival was associated with APRI above 0.9, blood loss of more than 400 mL, liver cirrhosis, multiple tumors, tumor size greater than 5 cm, microvascular invasion and satellite lesions. When the independent risk factors were integrated into the prognostic nomogram, it performed well with accurate predictions. Indeed, the performance was better than comparative prognosticators (<0.05 for all) with 0.752 as the C-index (95% CI: 0.706-0.798). These results were verified by the validation cohort.
APRI was a noninvasive and accurate predictive indicator for patients with early-stage HCC. Following hepatic resection to treat early-stage HCC, individualized patient survival predictions can be aided by the nomogram based on APRI.
预测肝切除术后早期肝细胞癌（HCC）患者的生存率。我们评估了天冬氨酸氨基转移酶与血小板比值指数（APRI）的预后潜力，以便用它来构建列线图模型。
我们将在本中心接受肝切除治疗的901例早期HCC患者随机分为训练队列和验证队列，随访时间为2009年1月至2012年12月。使用X-tile软件在训练队列中确定APRI的截断阈值。随后对验证队列进行评估以确定阈值的准确性。训练队列多变量分析产生的数据用于设计预后列线图。采用决策曲线分析（DCA）、一致性指数值（C指数）和校准曲线来确定列线图的性能。
X-tile软件显示，训练队列中区分不同预后患者的最佳APRI截断阈值为0.9。因此，我们验证了其预后价值。多变量分析表明，总生存期较差与APRI高于0.9、失血超过400 mL、肝硬化、多发肿瘤、肿瘤大小大于5 cm、微血管侵犯和卫星灶有关。当将独立危险因素纳入预后列线图时，其预测准确，性能良好。实际上，其性能优于其他比较性预后指标（所有P<0.05），C指数为0.752（95%CI：0.706-0.798）。验证队列验证了这些结果。
APRI是早期HCC患者的一种无创且准确的预测指标。在肝切除治疗早期HCC后，基于APRI的列线图有助于对患者的生存进行个体化预测。
