Albumin-to-Alkaline Phosphatase Ratio is an Independent Prognostic Indicator in Combined Hepatocellular and Cholangiocarcinoma

Abstract

Background: The clinical significance of Albumin-to-Alkaline Phosphatase Ratio (AAPR) has been discussed in hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). The aim of this study is to clarify the prognostic value of AAPR in patients with combined hepatocellular and cholangiocarcinoma (cHCC-CCA). Methods: A total of 267 patients pathologically diagnosed as Allen type C cHCC-CCA in our institution were retrospectively enrolled and randomly divided into the training (N=187) cohort and validation (N=80) cohort. The prognostic value of AAPR was evaluated and validated. An AAPR-based nomogram was constructed and its prediction performance was assessed. Results: We identified 0.43 as the optimal threshold value of AAPR by the X-tile software. In the training cohort, the median overall survival (OS) of patients with AAPR < 0.43 was significant shorter than that of those with AAPR ≥ 0.43(15.8 months vs 35 months, respectively, P < 0.001). Univariate and multivariate analyses demonstrated that AAPR was a strong indicator of OS. The concordance index (C-index), receiver operating characteristic (ROC) curves, likelihood ratio tests (LAT), Akaike information criteria (AIC) and decision curve analysis (DCA) demonstrated that AAPR outperformed the Child-Pugh (CP) grade and albumin-bilirubin (ALBI) grade in predicting OS. These findings were further verified in the validation cohort. The AAPR-based nomogram achieved C-index values of 0.76 (95%CI: 0.71-0.81) in the training cohort and 0.69 (95%CI: 0.60-0.78) in the validation cohort, which presented significant superiority to TNM stage. Conclusions: Preoperative AAPR is an independent prognostic predictor in cHCC-CCA. The AAPR-based nomogram contributes to personalized prognosis prediction and clinical decision making for cHCC-CCA.

Prediction of Survival and Analysis of Prognostic Factors for Patients With Combined Hepatocellular Carcinoma and Cholangiocarcinoma: A Population-Based Study

“…The TNM staging system has been one of the most commonly used tumor staging systems and is proven to be suitable for patients with CHC (2). However, a recent study (22) showed that its predictive power may not be as good as other standards. Based on the multivariate analysis, our nomogram-based model included three important variables (pathological grade, TNM stage, and surgical type) and could accurately categorize patients with CHC into different prognostic groups.…”

“…The AJCC TNM staging system is widely used to assess the severity and predict the prognosis of patients with HCC or ICC (20). Although the TNM staging system has been confirmed to be a prognostic system for CHC (2,21), its accuracy was not as remarkable as a serological model (22). However, many studies have shown that several independent risk factors, including age (23), race (5,9), alpha-fetoprotein (AFP) status (23), cirrhosis (4), and treatment strategies (1,5,9,(24)(25)(26), affect the survival and prognosis of patients with CHC.…”

“…However, many studies have shown that several independent risk factors, including age (23), race (5,9), alpha-fetoprotein (AFP) status (23), cirrhosis (4), and treatment strategies (1,5,9,(24)(25)(26), affect the survival and prognosis of patients with CHC. At present, some singlecenter studies have constructed many nomogram prediction models for CHC (22,(27)(28)(29)(30). Furthermore, studies have recently used the Surveillance, Epidemiology, and End Results (SEER) database to describe incidence trends and clinical outcomes of patients with CHC (1, 5); however, there was a lack of a nomogram to predict long-term survival.…”

Development and Validation of Nomogram to Predict Very Early Recurrence of Combined Hepatocellular-Cholangiocarcinoma After Hepatic Resection: A Multi-Institutional Study

“…Previous studies identi ed some variables, AFP, DCP , ALP , tumor size and tumor number, as independent risk factors for the recurrence of cHCC. 6,7,10,35,37,44 Nevertheless, these variables,of which the P value is small in univariable or multivariable analysis, were identi ed uncorrelated with VER of cHCC in other researches. We need more multi-institutional , large sample-sized and prospective studies to verify the conclusion.…”

Prognostic Significance of the Preoperative Albumin/Fibrinogen Ratio in Patients with Esophageal Squamous Cell Carcinoma after Surgical Resection

“…For all the statistical analyses, two statistical software programs were used: SPSS version 17.0 (SPSS, Inc., Chicago, IL) and R version 4.0.2 (The R Project for Statistical Computing, Vienna, Austria; http://www.r-project.org/). X-tile software version 3.6.1 (Yale University, New Haven, CT, USA) was used to determine the optimal cutoff values of these biomarkers for predicting 5-year OS by the minimal P-value approach [14]. The frequency of categorical variables was compared with the chi-squared test or Fisher's exact test.…”