Hepatobiliary Surgery Department, Guangxi Medical University Cancer Hospital, Nanning, China.
Hepatobiliary Surgery Department, The First People's Hospital of Qinzhou, Qinzhou, China.
BJS Open. 2024 Jan 3;8(1). doi: 10.1093/bjsopen/zrad155.
The prognostic significance of the aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio in hepatocellular carcinoma remains uncertain. The aim of the current study was to evaluate the association between the AST/ALT ratio and prognosis in patients with hepatocellular carcinoma after hepatectomy, and to explore the role of underlying liver diseases as mediators.
This retrospective study included patients with hepatocellular carcinoma who underwent hepatectomy between January 2014 and January 2018 at two Chinese hospitals. The maximally selected rank statistic and g-computation approach were used to quantify and visualize the association between the AST/ALT ratio and overall survival or recurrence-free survival. The role of mediators (chronic hepatitis B, hepatic steatosis and liver cirrhosis) was analysed.
Among the 1519 patients (mean(s.d.) age at baseline, 50.5(11.3) years), 1309 (86.2%) were male. During a median follow-up of 46.0 months, 514 (33.8%) patients died and 358 (23.6%) patients experienced recurrence. The optimal cut-off value for the AST/ALT ratio was 1.4, and the AST/ALT ratio greater than or equal to 1.4 was independently associated with a 39.0% increased risk of death and a 30.0% increased risk of recurrence (overall survival: hazard ratio (HR), 1.39; 95% c.i. 1.15 to 1.68; recurrence-free survival: HR, 1.30; 95% c.i. 1.12 to 1.52) after adjusting for confounders. Chronic hepatitis B significantly mediated the association of the ratio of AST/ALT with both overall survival and recurrence-free survival (20.3% for overall survival; 20.1% for recurrence-free survival).
The AST/ALT ratio greater than or equal to 1.4 was associated with shorter overall survival and recurrence-free survival in patients with hepatocellular carcinoma after hepatectomy, and chronic hepatitis B may play a role in their association.
天冬氨酸氨基转移酶/丙氨酸氨基转移酶（AST/ALT）比值在肝细胞癌中的预后意义仍不确定。本研究旨在评估 AST/ALT 比值与肝细胞癌患者肝切除术后预后的关系，并探讨潜在肝脏疾病作为中介的作用。
本回顾性研究纳入了 2014 年 1 月至 2018 年 1 月在中国两家医院接受肝切除术的肝细胞癌患者。采用最大选择秩统计和 g 计算方法来量化和可视化 AST/ALT 比值与总生存或无复发生存之间的关系。分析了中介（慢性乙型肝炎、肝脂肪变性和肝硬化）的作用。
在 1519 例患者（基线时平均（标准差）年龄，50.5（11.3）岁）中，1309 例（86.2%）为男性。中位随访 46.0 个月期间，514 例（33.8%）患者死亡，358 例（23.6%）患者复发。AST/ALT 比值的最佳截断值为 1.4，AST/ALT 比值大于或等于 1.4 与死亡风险增加 39.0%和复发风险增加 30.0%独立相关（总生存：风险比（HR），1.39；95%置信区间（CI）1.15 至 1.68；无复发生存：HR，1.30；95%CI 1.12 至 1.52），校正混杂因素后。慢性乙型肝炎显著介导了 AST/ALT 比值与总生存和无复发生存的关系（总生存为 20.3%；无复发生存为 20.1%）。
AST/ALT 比值大于或等于 1.4 与肝细胞癌患者肝切除术后总生存和无复发生存时间较短相关，慢性乙型肝炎可能在其相关性中发挥作用。
