Prognosis of hepatocellular carcinoma using the albumin to alkaline phosphatase ratio, literature review and meta analysis

Data about the impact of albumin-to-alkaline phosphatase ratio [AAPR] on prognosis in hepatocellular cancer patients are inconclusive and conflicting. We systematically searched literatures from 7 databases [PubMed, Medline, Web of Science, Cochrane Library, Embase, Google Scholar and CINAHL], updated to September, 2023. Hazard ratios [HRs] and 95% confidence intervals [CIs] were pooled and synthesized using Comprehensive Meta-Analysis version 3 in order to assess the overall impact of AAPR on patient’s prognosis. In total, 8 studies involving 13 cohorts with 3,774 cases were included. Pooled results from both univariate and multivariate analyses revealed that higher AAPR was an independent prognostic factor for overall survival [OS] [HR=0,429, 95% CI: 0,361–0,509, P=0,001; HR=0,476, 95% CI:0,421–0,538, P= 0,001; respectively]. Similarly, pooled multivariate results showed that higher AAPR was associated with better disease-free survival [DFS] [HR=0,558, 95% CI:0,452–0,688, P= 0,001]. Moreover, pooled results from both univariate and multivariate analyses revealed that higher AAPR was an independent prognostic factor for recurrence-free survival [RFS] [HR=0,540, 95% CI: 0,420–0,694, P=0,001; HR=0,647, 95% CI:0,494–0,848, P= 0,002; respectively]. Subgroups analysis showed that elevated AAPR still significantly correlated with better OS across the confounding factors. Moreover, sensitivity analysis suggested the robustness of these findings and no publication bias was detected. In summary, higher AAPR could be considered as a reliable prognostic factor in patients with HCC, which could be used as a routine inspection of HCC patients to individualized prognosis prediction and clinical decision making.