Abstract
BackgroundMost hepatocellular carcinoma (HCC) patients’ liver function indexes are abnormal. We aimed to investigate the relationship between (alkaline phosphatase + gamma-glutamyl transpeptidase)/lymphocyte ratio (AGLR) and the progression as well as the prognosis of HCC.MethodsA total of 495 HCC patients undergoing radical hepatectomy were retrospectively analyzed. We randomly divided these patients into the training cohort (n = 248) and the validation cohort (n = 247). In the training cohort, receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value of AGLR for predicting postoperative survival of HCC patients, and the predictive value of AGLR was evaluated by concordance index (C-index). Further analysis of clinical and biochemical data of patients and the correlation analysis between AGLR and other clinicopathological factors were finished. Univariate and multivariate analyses were performed to identify prognostic factors for HCC patients. Survival curves were analyzed using the Kaplan–Meier method.ResultsAccording to the ROC curve analysis, the optimal predictive cut-off value of AGLR was 90. The C-index of AGLR was 0.637 in the training cohort and 0.654 in the validation cohort, respectively. Based on this value, the HCC patients were divided into the low-AGLR group (AGLR ≤ 90) and the high-AGLR group (AGLR > 90). Preoperative AGLR level was positively correlated with alpha-fetoprotein (AFP), tumor size, tumor-node-metastasis (TNM) stage, and microvascular invasion (MVI) (all p < 0.05). In the training and validation cohorts, patients with AGLR > 90 had significantly shorter OS than patients with AGLR ≤ 90 (p < 0.001). Univariate and multivariate analyses of the training cohort (HR, 1.79; 95% CI 1.21–2.69; p < 0.001) and validation cohort (HR, 1.82; 95% CI 1.35–2.57; p < 0.001) had identified AGLR as an independent prognostic factor. A new prognostic scoring model was established based on the independent predictors determined in multivariate analysis.ConclusionsThe elevated preoperative AGLR level indicated poor prognosis for patients with HCC; the novel prognostic scoring model had favorable predictive capability for postoperative prognosis of HCC patients, which may bring convenience for clinical management.
Highlights
Most hepatocellular carcinoma (HCC) patients’ liver function indexes are abnormal
Previous studies have reported that Alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT) and lymphocyte count were independent prognostic predictors for liver cancer [3,4,5]; and ALP to lymphocyte count ratio or GGT to lymphocyte count ratio could serve as prognostic factors as well [5, 6]
It was assumed that a parameter composed of the two factors may have more favorable prognostic predictive capacity, and a prognosis prediction model made up of multiple factors was constructed: [ALP (U/L) + GGT (U/L)]/lymphocyte count (× 109/L) (AGLR), and this model may have great potential for postoperative prognosis prediction for HCC patients
Summary
We aimed to investigate the relationship between (alkaline phosphatase + gamma-glutamyl transpeptidase)/lymphocyte ratio (AGLR) and the progression as well as the prognosis of HCC. Researches on the critical factors affecting prognosis of liver cancer are of great significance to improve the therapeutic efficacy of HCC patients, and promote patient management. Alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT) are the representative enzymes in serum, as well as the parameters for liver function. It was assumed that a parameter composed of the two factors may have more favorable prognostic predictive capacity, and a prognosis prediction model made up of multiple factors was constructed: [ALP (U/L) + GGT (U/L)]/lymphocyte count (× 109/L) (AGLR), and this model may have great potential for postoperative prognosis prediction for HCC patients
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