Aspartate aminotransferase-to-platelet ratio index predicts prognosis of hepatocellular carcinoma after postoperative adjuvant transarterial chemoembolization

Gui-Qi Zhu; Kang Wang; Biao Wang; Yu-Jie Zhou; Yi Yang; Er-Bao Chen; Zheng-Jun Zhou; Shao-Lai Zhou; Ying-Hong Shi; Jian Zhou; Zhi Dai

doi:10.2147/CMAR.S186150

Aspartate aminotransferase-to-platelet ratio index predicts prognosis of hepatocellular carcinoma after postoperative adjuvant transarterial chemoembolization

Cancer Manag Res. 2018 Dec 20:11:63-79. doi: 10.2147/CMAR.S186150. eCollection 2019.

Authors

Gui-Qi Zhu^{1

2}, Kang Wang³, Biao Wang^{1

2}, Yu-Jie Zhou⁴, Yi Yang^{1

2}, Er-Bao Chen⁵, Zheng-Jun Zhou^{1

2}, Shao-Lai Zhou^{1

2}, Ying-Hong Shi^{1

2}, Jian Zhou^{1

2}, Zhi Dai^{1

2}

Affiliations

¹ Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China, dai.zhi@zs-hospital.sh.cn.
² State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, 200032, China, dai.zhi@zs-hospital.sh.cn.
³ Department of Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, 400016, China.
⁴ Department of Gastroenterology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China.
⁵ Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.

Abstract

Background and aim: To investigate the value of the aspartate aminotransferase-to-platelet ratio index (APRI) and build a new nomogram for hepatocellular carcinoma (HCC) patients undergoing postoperative adjuvant transarterial chemoembolization (PATACE).

Methods: We retrospectively reviewed 351 patients with HCC undergoing PATACE. We collected baseline HCC patient characteristics to obtain the risk factors for determining poor disease-free survival (DFS) and early time to recurrence (TTR) after PATACE. The multivariate Cox proportional hazards model was used to build new nomogram based on significant prognostic factors of outcomes.

Results: We generated the cutoff value of the APRI as 0.50 using the X-tile to distinguish patients with different outcomes in the whole cohort. Two hundred seventeen patients with high APRI had poorer survival (P<0.001) than did 134 patients with low APRI. Furthermore, a nomogram, including tumor size, alanine aminotransferase (ALT) level, white blood cell counts, Barcelona Clinic Liver Cancer grade, and APRI was built for DFS, while factors including hepatitis B surface antigen, tumor size, ALT, microvascular invasion, and APRI was built for TTR. Internal validation with 500 bootstrapped sample sets had a good concordance index of 0.729 for DFS and 0.730 for TTR. Additionally, nomogram based on APRI conferred more prognostic value than previous biomarkers.

Conclusion: High APRI was associated with worse survival and shorter TTR for HCC patients undergoing PATACE. This simple nomogram based on APRI conferred personalized survival and recurrence data for HCC patients undergoing PATACE.

Keywords: adjuvant transarterial chemoembolization; aspartate aminotransferase-to-platelet ratio index; hepatocellular carcinoma; nomogram; prognosis.