4.6 Review

Assessment of Prognostic Value of Aspartate Aminotransferase-to-Platelet Ratio Index in Patients With Hepatocellular Carcinoma: Meta-Analysis of 28 Cohort Studies

Journal

FRONTIERS IN MEDICINE
Volume 8, Issue -, Pages -

Publisher

FRONTIERS MEDIA SA
DOI: 10.3389/fmed.2021.756210

Keywords

hepatocellular carcinoma; aspartate aminotransferase-to-platelet ratio index; APRI; noninvasive biomarker; prognosis; overall survival; disease-free survival; meta-analaysis

Funding

  1. Talent Introduction and Research Start-up Fund of Southwest Medical University [00040056]
  2. Joint Project of the Southwest Medical University-Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University [6-51]
  3. Sichuan Provincial Administration of Traditional Chinese Medicine Project [13-130]
  4. Science & Technology Department of Sichuan Provincial Project [2021YFH0150]
  5. People's Government of Luzhou City-Southwest Medical University High-level Talent Introduction Special Funding Project [2017RC-002]
  6. [2021]

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The study found that elevated APRI levels are significantly associated with poor prognosis in patients with HCC. In most cases, pretreatment APRI can be used as an independent prognostic factor, but it is necessary to incorporate other predictive prognostic systems to ensure accuracy.
Background: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors globally; it is valuable to predict its prognosis after treatment. Aspartate aminotransferase-to-platelet index (APRI), a non-invasive biomarker consists of two routine test parameters easily available in all the patients. Our study aimed to investigate whether APRI can serve as an independent prognostic marker in the patients with HCC.Methods: We extensively searched PubMed, Embase, and Web of Science databases on June 20, 2021 to determine all relevant literature. The studies that explored the association between the APRI levels and prognosis of patients with HCC and reported risk estimate data were included. The Newcastle-Ottawa Scale was used to assess the quality of the included studies.Results: A total of 1,097 articles were initially identified, of which 28 studies involving 11,041 patients met the eligibility criteria for the meta-analysis. The pooled hazard ratios (HRs) for overall survival (OS) and disease-free survival (DFS) were 1.77 (95% CI: 1.53-2.05, P < 0.001) and 1.59 (95% CI: 1.47-1.71, P < 0.001), respectively, suggesting a significant correlation between the increased APRI levels and poor prognosis in the patients with HCC. In the subgroup analyses, statistical significance of the correlation disappeared in the Korean and Japanese population and in the patients undergoing transarterial chemoembolization (TACE). Of note, the current results may be overestimated due to publication bias, but the conclusion remained unchanged when the bias was adjusted.Conclusion: High APRI levels are associated with poor OS and DFS in the patients with HCC. In most cases, pretreatment APRI can be used as an independent prognostic factor, but it is necessary to incorporate other predictive prognostic systems to ensure accuracy. Further studies are needed to determine the specific beneficiary population and the optimal cutoff value.

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