Prognostic effect of albumin-to-alkaline phosphatase ratio on patients with hepatocellular carcinoma: a systematic review and meta-analysis.

Abstract

Abstract Background The prognostic value of albumin-to-alkaline phosphatase ratio (AAPR) in patients with hepatocellular carcinoma (HCC) remains controversial. This meta-analysis aims to evaluate the prognostic role of AAPR in patients with HCC. Methods The databases of Web of Science, Embase, Cochrane Library and PubMed were comprehensively searched from inception to April 25, 2022. Pooled hazard ratio (HR) and 95% confidence interval (CI) were calculated with Stata 16.0 software for the assessment of the relationship between AAPR and overall survival (OS) as well as disease-free survival (DFS) in patients with HCC. Results A total of 2634 patients from 12 cohorts were included in this meta-analysis. The pooled results showed that lower AAPR was significantly associated with poorer OS (HR: 2.02, 95% CI: 1.78–2.30). Similarly, pooled results demonstrated that lower AAPR was also significantly associated with poorer DFS (HR: 1.61, 95% CI: 1.36–1.92). Heterogeneity for DFS and publication bias for OS existed, however, the subgroup analysis, meta-regression analysis as well as adjustment using trim-and-fill analysis confirmed a stable interaction between AAPR and OS as well as DFS. Conclusions This meta-analysis proves that lower AAPR was significantly associated with poorer OS and DFS in patients with HCC, and AAPR could be a promising indicator for prognosis of HCC.