Background Albumin-to-Alkaline Phosphatase Ratio (ALB/ALP ratio, AAPR), a newly developed index of liver function, has been rarely discussed about its prognostic value in malignancies. The current study attempted to evaluate the prognostic prediction of AAPR in advanced HCC.Methods 237 advanced HCC patients who refused any standard anti-cancer therapies were retrospectively analyzed. The threshold value of AAPR was determined by receiver operating characteristic (ROC) curve. Univariate analyses using Kaplan-Meier method and log-rank test, and multivariate analysis using Cox proportional hazards regression model were conducted. Comparisons of ROC curves and likelihood ratio test (LRT) were utilized to compare the value of different factors in predicting survival.Results ROC curve analysis confirmed 0.38 as the optimal cutoff value of AAPR in evaluating overall survival (OS). Patients with an AAPR > 0.38 exhibited significantly lower frequencies of ascites, portal vein tumor thrombus, Child-Pugh grade B & C, and KPS < 70 (all P < 0.05). These patients also displayed a longer median survival time than those with an AAPR ≤ 0.38 (5.8 m vs 2.4 m, P < 0.01). Univariate and multivariate analyses identified AAPR as an independent prognostic indicator (HR = 0.592, P = 0.007). Furthermore, we integrated AAPR with TNM system and found that area under curve of AAPR-TNM system was significantly larger than that of TNM system when predicting 3-month survival (0.670 vs 0.611, P < 0.01). Moreover, LRT indicated that AAPR-TNM system had a significantly larger χ2 (26.4 vs 16.4, P < 0.01) and a significantly smaller Akaike information criterion value (1936 vs 1948, P < 0.01) comparing with TNM system.Conclusions Our study implied that AAPR was a potentially valuable prognostic index for advanced HCC patients without receiving any standard anti-cancer therapies. AAPR-TNM system preceded TNM system in predicting overall survival in this study.
Minimum and maximum soil surface temperatures have shown significant warming trends since the midtwentieth century in China, with minimum temperatures rising at a faster pace than maximums, resulting in a decrease in the soil surface diurnal temperature range. Similar to air temperature, these changes demonstrate spatial coherence, with regions at higher latitudes experiencing relatively more change. While increases in air temperatures in China slowed after 1998, paralleling the global “warming hiatus,” soil temperatures at the surface and in shallow layers have continued to rise across China. The increases in soil surface temperatures are fastest at night since 1998, reducing the soil surface diurnal temperature range. Thus, we find that while the decrease in the diurnal air temperature range mainly happened during the earlier “dimming” period ending around 1988, the decrease in the diurnal soil surface temperature range is detectable only during the renewed dimming period after 1998. This has caused soil temperatures at the surface and in shallow layers to diverge from air temperatures since 1998. Although changes in soil temperatures were associated with changes in air temperature, the patterns of change are different. Calculations using only nonurban stations show similar warming rates, indicating that the effects of urbanization are small.
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