Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2019; 11(1): 39-47
Published online Jan 15, 2019. doi: 10.4251/wjgo.v11.i1.39
Albumin-to-alkaline phosphatase ratio: A novel prognostic index of overall survival in cholangiocarcinoma patients after surgery
Jian-Ping Xiong, Jun-Yu Long, Wei-Yu Xu, Jin Bian, Han-Chun Huang, Yi Bai, Yi-Yao Xu, Hai-Tao Zhao, Xin Lu
Jian-Ping Xiong, Jun-Yu Long, Wei-Yu Xu, Jin Bian, Han-Chun Huang, Yi Bai, Yi-Yao Xu, Hai-Tao Zhao, Xin Lu, Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Author contributions: Xiong JP, Long JY and Xu WY contributed equally to this work; Xiong JP conceived, designed and wrote the manuscript that led to the submission; Xu WY and Long JY searched and filtered the literature; Bai Y and Huang HC selected and interpreted the data; Bian J and Xu YY revised the manuscript; Zhao HT and Lu X provided financial support for this work; All authors read and approved the final manuscript.
Supported by National Key Project Research and Development Projects, No. S2016G9012; International Science and Technology Cooperation Projects, No. 2015DFA30650; and the Capital Special Research Project for Clinical Application, No. Z151100004015170.
Institutional review board statement: This study gained approval from the Institutional Review Board of PUMCH.
Informed consent statement: All patients and their families signed informed consent statements before surgery, and the type of surgical procedure was performed according to the approved guidelines.
Conflict-of-interest statement: We declare that the authors have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xin Lu, MD, Professor, Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Wangfujing, Beijing 100730, China. luxinln@163.com
Telephone: +86-10-69156042 Fax: +86-10-69156042
Received: September 18, 2018
Peer-review started: September 18, 2018
First decision: October 18, 2018
Revised: October 29, 2018
Accepted: December 4, 2018
Article in press: December 5, 2018
Published online: January 15, 2019
Abstract
AIM

To clarify the prognostic significance of preoperative albumin-to-alkaline phosphatase ratio (AAPR) in cholangiocarcinoma (CCA) subjects receiving surgery.

METHODS

In this retrospective study, we included 303 CCA patients receiving surgery without preoperative therapy between 2002 and 2014. Clinicopathological characteristics (including AAPR) were analyzed to determine predictors of post-operative overall survival and recurrence-free survival (RFS). In addition, univariate and multivariate Cox proportional hazards models were conducted, followed by application of time-dependent receiver operating curves to identify the optimal cut-off.

RESULTS

Univariate and multivariate analyses revealed both decreased overall survival [hazard ratio (HR): 2.88, 95%CI: 1.19-5.78] and recurrence-free survival (HR: 2.31, 95%CI: 1.40–3.29) in patients with AAPR < 0.41 compared to those with AAPR ≥ 0.41. The optimal cut-off of AAPR was 0.41. Of the 303 subjects, 253 (83.5%) had an AAPR over 0.41. The overall 1-, 3- and 5-year survival rates were 70.2%, 38.0% and 16.5%, respectively in the low (< 0.41) AAPR group, which were significantly lower than those in the high (≥ 0.41) AAPR group (81.7%, 53.9%, and 33.4%, respectively) (P < 0.0001). Large tumor size, multiple tumors, and advanced clinical stage were also identified as significant predictors of poor prognosis.

CONCLUSION

Our outcomes showed that AAPR was a potential valuable prognostic indicator in CCA patients undergoing surgery, which should be further confirmed by prospective studies. Moreover, it is necessary to investigate the mechanisms concerning the correlation of low AAPR with poor post-operative survival in CCA patients.

Keywords: Albumin-to-alkaline phosphatase ratio, Cholangiocarcinoma, Prognosis, Surgery, Survival

Core tip: Certain combinations of clinical features and laboratory indexes have been validated as prognostic indicators, including albumin to gamma-glutamyltransferase ratio, neutrophil-to-lymphocyte ratio as well as platelet to albumin ratio. Nevertheless, albumin-to-alkaline phosphatase ratio (AAPR), a novel indicator for the prognosis of hepatocellular carcinoma, has not been examined in cholangiocarcinoma (CCA). Hence, it is intriguing to confirm the potential application of AAPR in CCA. Our findings demonstrated that AAPR is a potential prognostic indicator in CCA subjects undergoing surgery.