Backgroud: Most liver cancer patients have backgroud of HBV-related liver cirrhosis. We are still not sure whether non-invasive assessments of liver fibrosis can be used as predictors of prognosis. In this study, we investigate the relationship between aspartate aminoytransferase (AST)-to-platelet(PLT) ratio index (APRI) and the prognosis of hepatocellular carcinoma (HCC) patients with liver cirrhosis.
Methods: The clinical data of HCC patients with cirrhosis who received hapatectomy in our hospital were analyzed retrospectively. Receiver Operating Characteristic (ROC) curve was used to determine APRI cut-off value to predict the prognosis. Kaplan-Meier survival (Log-rank test) and Cox regression analyses were used for univariate and multivariate analysis of the prognosis in all patients, and the differences were compared between the APRI high-value and low-value groups. Independent sample t test was used to compare the differences of clinical data between the APRI high-value and low-value groups.
Results: The cut-off value was determined as 0.61 according to the ROC curve, and the high-value group was defined as APRI ≥ 0.61, while the low-value group was defined as APRI<0.61. By the end of follow-up data, the proportion of patients died from liver failure in high-value group was higher than that in low-value group (χ2 =5.232, P=0.022). The results of survival analysis showed that the maximum of tumor diameter >0.5cm, multiple tumors, invasion of liver capsule, vascular tumor thrombus, AFP>20ng/ml and APRI ≥ 0.61were independent risk factors influencing the disease free survival (DFS) time after resection for HCC patients with cirrhosis (P<0.05). The 1-year, 2-year, and 5-year disease free survival rates of APRI low-value and high-value groups were 79.4%, 61.4%, 43.7% and 71.4%, 51.6%, 27.0%. The recurrence rate of APRI low-value and high-value groups were 20.5%, 38.1%, 54.1% and 28.0%, 47.1%, 69.8%, respectively (P=0.000). APRI value of patients with portal hypertension (PH) and Child-pugh B class were higher than those without PH and Child-pugh A class (P<0.05).
Conclusion: HCC patients with liver cirrhosis whose APRI ≥ 0.61 had worse prognosis after resection.