Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
Clin Radiol. 2023 Apr;78(4):301-309. doi: 10.1016/j.crad.2022.12.006. Epub 2023 Jan 11.
To reveal the prognostic value of the postoperative and dynamic albumin-to-alkaline phosphatase ratio (AAPR) in hepatocellular carcinoma (HCC) patients undergoing trans-catheter chemoembolisation (TACE).
In total, 545 HCC patients undergoing initial TACE were enrolled into the study. The receiver operating characteristic (ROC) curve was plotted to determine the best cut-off for AAPR. Univariate and multivariate Cox regression analyses were used to confirm the independent prognostic effect of AAPR on overall survival (OS). The predictive performance of AAPR was assessed by ROC curves, concordance index (C-index), and Akaike information criterion (AIC), and was compared to existing liver function assessment systems.
The optimal cut-off value for the AAPR was 0.26. Elevated AAPR (>0.26) was associated with a low risk of death after adjustment whether before (HR: 0.53; 95% CI: 0.4-0.69) or after (HR: 0.64; 95% CI: 0.43-0.95) TACE treatment. The combined pre- and postoperative AAPR showed much better performance in ROC curve (1-, 3-, and 5-year AUCs: 0.69, 0.71, 0.69), C-index (0.65; 95% CI: 0.59-0.72) and AIC analyses than pre-AAPR and post-AAPR alone or liver function assessment systems.
This study demonstrated both preoperative and postoperative AAPR were independent prognostic factors for HCC patients undergoing TACE. In addition, the combined pre- and post-AAPR showed better predictive performance than pre-AAPR and post-AAPR alone or liver function assessment systems.
揭示经导管肝动脉化疗栓塞术（TACE）治疗后和动态白蛋白-碱性磷酸酶比值（AAPR）对肝细胞癌（HCC）患者的预后价值。
共纳入 545 例初次接受 TACE 的 HCC 患者。通过绘制受试者工作特征（ROC）曲线确定 AAPR 的最佳截断值。采用单因素和多因素 Cox 回归分析证实 AAPR 对总生存（OS）的独立预后影响。通过 ROC 曲线、一致性指数（C 指数）和赤池信息量准则（AIC）评估 AAPR 的预测性能，并与现有肝功能评估系统进行比较。
AAPR 的最佳截断值为 0.26。调整 TACE 治疗前后（HR：0.53；95%CI：0.4-0.69），AAPR 升高（>0.26）与死亡风险较低相关。术前和术后联合 AAPR 在 ROC 曲线（1、3 和 5 年 AUC：0.69、0.71、0.69）、C 指数（0.65；95%CI：0.59-0.72）和 AIC 分析中表现优于单独的术前和术后 AAPR 或肝功能评估系统。
本研究表明，术前和术后 AAPR 均是 TACE 治疗 HCC 患者的独立预后因素。此外，术前和术后联合 AAPR 比单独的术前和术后 AAPR 或肝功能评估系统具有更好的预测性能。
