Albumin-to-Alkaline Phosphatase Ratio: A Novel Prognostic Index for Hepatocellular Carcinoma

• Main Authors: Anthony W. H. Chan, Stephen L. Chan, Frankie K. F. Mo, Grace L. H. Wong, Vincent W. S. Wong, Yue-Sun Cheung, Henry L. Y. Chan, Winnie Yeo, Paul B. S. Lai, Ka-Fai To
• Format: Article
• Language: English
• Published: Hindawi Limited 2015-01-01
• Series: Disease Markers
• Online Access: http://dx.doi.org/10.1155/2015/564057
• ISSN: 0278-0240; 1875-8630

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 χ2 (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.