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

Authors Huang J, Yang Y, Xia Y, Liu FC, Liu L, Zhu P, Yuan SX, Gu FM, Fu SY, Zhou WP, Liu H, Jiang BG, Pan ZY

Received 1 October 2020

Accepted for publication 8 January 2021

Published 19 February 2021 Volume 2021:13 Pages 1733—1746


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Ahmet Emre Eşkazan

Jian Huang,1,* Yun Yang,1,* Yong Xia,2,* Fu-Chen Liu,1,* Lei Liu,1 Peng Zhu,1 Sheng-Xian Yuan,1 Fang-Ming Gu,1 Si-Yuan Fu,1 Wei-Ping Zhou,1 Hui Liu,1 Bei-Ge Jiang,1 Ze-Ya Pan1

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

*These authors contributed equally to this work

Correspondence: Ze-Ya Pan; Bei-Ge Jiang No. 700, MoYu North Road, Jiading, Shanghai, People’s Republic of China
Tel +86-13391236437
; +86-13764561303

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: hepatocellular carcinoma, hepatic resection, survival, nomogram, aspartate aminotransferase to platelet ratio index, APRI

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