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Preoperative Aspartate Aminotransferase to Platelet Ratio is an Independent Prognostic Factor for Hepatitis B-Induced Hepatocellular Carcinoma After Hepatic Resection

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There is conflicting evidence concerning platelet status and hepatocellular carcinoma (HCC) prognosis. We evaluated the prognostic value of platelet-based indices, including platelet count, platelet/lymphocyte ratio (PLR), and aspartate aminotransferase to platelet ratio index (APRI) in HCC after hepatic resection.

Methods

We retrospectively reviewed 332 patients with HCC treated with hepatectomy between 2006 and 2009. Preoperative platelet count, as well as demographic, clinical, and pathologic data, were analyzed.

Results

Both disease-free survival (DFS) and overall survival (OS) were significantly improved for patients with low platelet count, PLR, and APRI compared to patients with elevated values. On multivariate analysis, APRI, tumor size ≥5 cm, noncapsulation, and multiple tumors were all associated with both poor DFS and OS. The 1-, 3-, and 5-year DFS rates were 52, 36, and 32 % for patients with APRI <0.62 and were 35, 22, and 19 % for patients with APRI ≥0.62. Correspondingly, the 1-, 3-, and 5-year OS rates were 77, 51, and 42, and 63, 35, and 29 % for both groups. Both DFS and OS of patients with APRI <0.62 were significantly better compared to patients with an elevated APRI (P = 0.009 and 0.002, respectively). Patients with elevated APRI tended to have cirrhosis, hepatitis B virus (HBV) infection, surgical margin <1 cm, and noncapsulated tumors.

Conclusions

Elevated platelets based inflammatory indices, especially APRI, was associated with adverse characteristic features and poor prognosis in HCC, especially for patients with HBV infection or cirrhosis. Antiplatelet treatment may represent a potential therapy for HBV-induced HCC recurrence.

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Acknowledgment

We thank Professor Stephen Tomlinson from the Department of Microbiology and Immunology, Medical University of South Carolina, for his review and comments.

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

    Shun-Li Shen MD, PhD, Shun-Jun Fu MD, Bin Chen MD, PhD, Ming Kuang MD, PhD, Shao-Qiang Li MD, PhD, Yun-Peng Hua MD, PhD, Li-Jian Liang MD & Bao-Gang Peng MD, PhD

  2. Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China

    Pi Guo MD & Yuantao Hao MD, PhD

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  1. Shun-Li Shen MD, PhD
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  2. Shun-Jun Fu MD
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  10. Bao-Gang Peng MD, PhD
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Corresponding author

Correspondence to Bao-Gang Peng MD, PhD.

Additional information

Shun-Li Shen and Shun-Jun Fu have contributed equally to this article, and both should be considered first author.

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Supplement Fig. 1

Receiver operating characteristic curves of preoperative PLR (a) and APRI (b) for predicting tumor recurrence in patients with hepatocellular carcinoma (HCC) after hepatic resection (TIF 113 kb)

Supplement Fig. 2

Kaplan-Meier survival curves of HCC patients with after hepatectomy. The patients were divided into platelet <300/mm3 group and platelet ≥300/mm3 group. a Disease-free survival of patients with platelet ≥300/mm3 was shorter than those with platelet <300/mm3 (P = .009, log-rank). b Overall survival of patients with platelet ≥300/mm3 was also shorter than those with platelet <300/mm3 (P = .02, log-rank). (TIF 148 kb)

Supplement Fig. 3

Kaplan--Meier survival curves of HCC patients after hepatectomy. The patients were divided into PLR <115 group and PLR ≥115 group by the optimal cut-off value of PLR. a Disease-free survival of patients with PLR ≥115 was shorter than those with PLR <115 (P = .026, log-rank). b Overall survival of patients with PLR ≥115 was also shorter than those with PLR <115 (P = .007, log-rank). (TIF 151 kb)

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Shen, SL., Fu, SJ., Chen, B. et al. Preoperative Aspartate Aminotransferase to Platelet Ratio is an Independent Prognostic Factor for Hepatitis B-Induced Hepatocellular Carcinoma After Hepatic Resection. Ann Surg Oncol 21, 3802–3809 (2014). https://doi.org/10.1245/s10434-014-3771-x

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