Prediction of Patient Survival Following Hepatic Resection in Early-Stage Hepatocellular Carcinoma with Indexed Ratios of Aspartate Aminotransferase to Platelets: A Retrospective Cohort Study

Jian Huang; Yun Yang; Yong Xia; Fu-Chen Liu; Lei Liu; Peng Zhu; Sheng-Xian Yuan; Fang-Ming Gu; Si-Yuan Fu; Wei-Ping Zhou; Hui Liu; Bei-Ge Jiang; Ze-Ya Pan

doi:10.2147/CMAR.S284950

Prediction of Patient Survival Following Hepatic Resection in Early-Stage Hepatocellular Carcinoma with Indexed Ratios of Aspartate Aminotransferase to Platelets: A Retrospective Cohort Study

Cancer Manag Res. 2021 Feb 19:13:1733-1746. doi: 10.2147/CMAR.S284950. eCollection 2021.

Authors

Jian Huang^#¹, Yun Yang^#¹, Yong Xia^#², Fu-Chen Liu^#¹, Lei Liu¹, Peng Zhu¹, Sheng-Xian Yuan¹, Fang-Ming Gu¹, Si-Yuan Fu¹, Wei-Ping Zhou¹, Hui Liu¹, Bei-Ge Jiang¹, Ze-Ya Pan¹

Affiliations

¹ The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University (Second Military Medical University), Shanghai, 201805, People's Republic of China.
² Department of Medical Oncology, Shanghai Mengchao Cancer Hospital, Shanghai, 201805, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: To predict patient survival in early-stage hepatocellular carcinoma (HCC) following hepatic resection. We evaluated the prognostic potential of the aspartate aminotransferase to platelet ratio index (APRI) in order to use it to model a nomogram.

Patients and methods: We randomized 901 early-stage HCC patients treated with hepatic resection at our center into training and validation cohorts that were followed from January 2009 to December 2012. X-tile software was used to establish the APRI cut-off threshold in the training cohort. The validation cohort was subsequently assessed to determine threshold value accuracy. Data generated from the multivariate analysis in the training cohort were used to design a prognostic nomogram. Decision curve analyses (DCA), concordance index values (C-index) and calibration curves were used to determine the performance of the nomogram.

Results: X-tile software revealed that the optimal APRI cut-off threshold in the training cohort that distinguished between patients with different prognoses was 0.9. We, therefore, validated its prognostic value. Multivariate analyses showed that poor overall survival was associated with APRI above 0.9, blood loss of more than 400 mL, liver cirrhosis, multiple tumors, tumor size greater than 5 cm, microvascular invasion and satellite lesions. When the independent risk factors were integrated into the prognostic nomogram, it performed well with accurate predictions. Indeed, the performance was better than comparative prognosticators (P<0.05 for all) with 0.752 as the C-index (95% CI: 0.706-0.798). These results were verified by the validation cohort.

Conclusion: APRI was a noninvasive and accurate predictive indicator for patients with early-stage HCC. Following hepatic resection to treat early-stage HCC, individualized patient survival predictions can be aided by the nomogram based on APRI.

Keywords: APRI; aspartate aminotransferase to platelet ratio index; hepatic resection; hepatocellular carcinoma; nomogram; survival.

Grants and funding

This study was supported by grants from the National Natural Science Foundation of China (81672721, 81772529, 81970453) and the Innovation Program of Shanghai Municipal Education Commission (12ZZ077).