Impact of albumin–lymphocyte–platelet–C‐reactive protein index as a prognostic indicator of hepatocellular carcinoma after resection: Associated with nuclear factor erythroid 2–related factor 2

Abstract Aim To investigate the prognostic value of the preoperative albumin–lymphocyte–platelet–C‐reactive protein (ALPC) index in patients with hepatocellular carcinoma (HCC) undergoing curative hepatectomy. We also evaluated the relationship between the ALPC index and the phosphorylated nuclear factor erythroid 2‐related factor 2 (p‐Nrf2) levels. Methods Data were analyzed retrospectively from 256 patients who underwent resection for HCC. For cross‐validation, patients were divided into the training and testing cohort. We assessed eight combinations of inflammatory markers for predictive value for recurrence. We examined the associations of the ALPC index with recurrence‐free survival and overall survival in univariate and multivariate analyses (Cox proportional hazards model). Immunohistochemical staining of p‐Nrf2 was performed on tumor samples of 317 patients who underwent hepatic resection for HCC. Results A high preoperative ALPC index correlated with a high serum albumin concentration, small tumor size, low rate of poor differentiation, solitary tumor, early Barcelona Clinic Liver Cancer stage, and low rate of microscopic intrahepatic metastasis in the training dataset. A high preoperative ALPC index correlated with a high serum albumin concentration, high serum alpha‐fetoprotein concentration, small tumor size, a low rate of poor differentiation and a low rate of microscopic intrahepatic metastasis in the testing dataset. A higher preoperative ALPC index was an independent predictor of longer recurrence‐free survival and overall survival in the training and testing datasets. A high ALPC index was associated with negative p‐Nrf2 expression in HCC tumor cells. Conclusions We showed that a high ALPC index was an independent prognostic factor for patients with HCC undergoing curative hepatic resection.