Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
BMC Surg. 2022 Aug 9;22(1):307. doi: 10.1186/s12893-022-01751-4.
This study aimed to evaluate the clinical significance of the preoperative aminotransferase to albumin ratio (AAR) in patients with hepatocellular carcinoma (HCC) after hepatectomy.
From five hospitals, a total of 991 patients with HCC admitted between December 2014 and December 2019 were included as the primary cohort and 883 patients with HCC admitted between December 2010 and December 2014 were included as the validation cohort. The X-tile software was conducted to identify the optimal cut-off value of AAR.
In the primary cohort, the optimal cut-off value of the AAR was defined as 0.7 and 1.6, respectively. Compared to patients with AAR 0.7-1.6, those with AAR > 1.6 showed significantly worse overall survival (OS) and RFS, whereas those with AAR < 0.7 showed significantly better OS and RFS (all p < 0.001). Pathologically, patients with AAR > 1.6 had more aggressive tumour characteristics, such as larger tumour size, higher incidence of microvascular invasion, and severe histologic activity, and higher AFP level than patients with AAR < 0.7. Consistently, the abovementioned clinical significance of AAR was confirmed in the validation cohort.
A high AAR was significantly correlated with advanced tumours and severe hepatic inflammation, and a worse prognosis of HCC.
本研究旨在评估肝切除术后肝细胞癌（HCC）患者术前谷草转氨酶/白蛋白比值（AAR）的临床意义。
本研究纳入了 2014 年 12 月至 2019 年 12 月期间在五家医院接受治疗的 991 例 HCC 患者作为主要队列，纳入了 2010 年 12 月至 2014 年 12 月期间在同五家医院接受治疗的 883 例 HCC 患者作为验证队列。使用 X-tile 软件确定 AAR 的最佳截断值。
在主要队列中，AAR 的最佳截断值分别定义为 0.7 和 1.6。与 AAR 为 0.7-1.6 的患者相比，AAR>1.6 的患者的总生存期（OS）和无复发生存期（RFS）明显更差，而 AAR<0.7 的患者的 OS 和 RFS 明显更好（均 P<0.001）。病理上，AAR>1.6 的患者具有更具侵袭性的肿瘤特征，如肿瘤更大、微血管侵犯发生率更高、组织学活动更严重以及 AFP 水平更高，与 AAR<0.7 的患者相比差异具有统计学意义。同样，AAR 的上述临床意义在验证队列中得到了证实。
高 AAR 与肿瘤进展和严重肝炎症相关，是 HCC 预后不良的一个显著标志。
