The prognostic value of aspartate aminotransferase‐to‐lymphocyte ratio index in early‐stage hepatocellular carcinoma after hepatectomy: A propensity‐score matched analysis

Abstract Background An elevated preoperative aspartate aminotransferase‐to‐lymphocyte ratio index (ALRI) may predict poor survival in various cancers. However, the prognostic value of aminotransferase‐to‐lymphocyte ratio index (ALRI) in patients with hepatocellular carcinoma (HCC) remains to be determined. Materials and methods A retrospective cohort study was conducted among 983 patients with HCC in our hospital from February 2007 to March 2016. A propensity‐score matching (PSM) was performed to correct the selection bias and confounding factors. The risk of death and recurrence was plotted over aminotransferase‐to‐lymphocyte ratio index (ALRI) using the locally weighted scatterplot smoothing (LOWESS)‐smoothed fit curve. Time‐dependent receiver operating characteristic (ROC) and Kaplan–Meier method analysis was utilized to the role of aminotransferase‐to‐lymphocyte ratio index (ALRI) in HCC. Multivariate analysis was conducted to identify independent prognostic factors associated with overall survival (OS) and recurrence‐free survival (RFS). Results With the increase of aminotransferase‐to‐lymphocyte ratio index (ALRI), the risk of recurrence and death in HCC patients increases. In time‐dependent ROC analysis, the AUC of aminotransferase‐to‐lymphocyte ratio index (ALRI) for predicting 1‐, 3‐ and 5‐year OS were 0.668 (95% CI: 0.596‐0.740), 0.605 (95% CI: 0.560‐0.649) and 0.613 (95% CI: 0.570‐0.656), respective. The AUC of aminotransferase‐to‐lymphocyte ratio index (ALRI) for predicting 1‐, 3‐ and 5‐year RFS were 0.598 (95% CI: 0.555‐0.641), 0.590 (95% CI: 0.552‐0.628) and 0.604 (95% CI: 0.562‐0.646), respectively. HCC patients with high aminotransferase‐to‐lymphocyte ratio index (ALRI) had a poor overall survival. Moreover, cox regression analysis revealed that aminotransferase‐to‐lymphocyte ratio index (ALRI) was an independent factor affecting the prognosis of HCC patients. Conclusions Elevated preoperative aminotransferase‐to‐lymphocyte ratio index (ALRI) is a noninvasive, simple, and effective predictor in the prognosis of patients with HCC.