Albumin-to-alkaline phosphatase ratio: a novel prognostic index for hepatocellular carcinoma.
Prognosis of patients with hepatocellular carcinoma (HCC) depends on both tumour extent and hepatic function reserve. Liver function test (LFT) is a basic routine blood test to evaluate hepatic function. We first analysed LFT components and their associated scores in a training cohort of 217 patients who underwent curative surgery to identify LFT parameters with high performance (discriminatory capacity, homogeneity, and monotonicity of gradient). We derived a novel index, albumin-to-alkaline phosphatase ratio (AAPR), which had the highest c-index (0.646) and χ(2) (24.774) among other liver biochemical parameters. The AAPR was an independent prognostic factor for overall and disease-free survival. The adjusted hazard ratio of death and tumour relapse was 2.36 (P = 0.002) and 1.85 (P = 0.010), respectively. The independent prognostic significance of AAPR on top of 5 commonly used and well established staging systems was further confirmed in 2 independent cohorts of patients receiving surgical resection (n = 256) and palliative therapy (n = 425). In summary, the AAPR is a novel index readily derived from a simple low-cost routine blood test and is an independent prognostic indicator for patients with HCC regardless of treatment options.
Department of Anatomical and Cellular Pathology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Anthony W H
AW
Chan
Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong ; Institute of Digestive Disease, Partner State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong.
Stephen L
0000-0001-5807-7447
SL
Chan
Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Frankie K F
FK
Mo
Institute of Digestive Disease, Partner State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong ; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.
Grace L H
GL
Wong
Institute of Digestive Disease, Partner State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong ; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.
Vincent W S
VW
Wong
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong.
Yue-Sun
YS
Cheung
Institute of Digestive Disease, Partner State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong ; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.
Henry L Y
HL
Chan
Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Winnie
W
Yeo
Institute of Digestive Disease, Partner State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong ; Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong.
Paul B S
PB
Lai
Department of Anatomical and Cellular Pathology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong ; Institute of Digestive Disease, Partner State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong ; Li Ka Shing Institute of Health Science, Sir Y. K. Pao Cancer Centre, The Chinese University of Hong Kong, Shatin, Hong Kong.
Ka-Fai
KF
To
D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000473:pathology; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012709:Serum Albumin / Q000378:metabolism*; D016019:Survival Analysis
D014408:Biomarkers, Tumor; D012709:Serum Albumin; D000469:Alkaline Phosphatase