AGLR is a novel index for the prognosis of hepatocellular carcinoma patients: a retrospective study.
BACKGROUND
Most hepatocellular carcinoma (HCC) patients' liver function indexes are abnormal. We aimed to investigate the relationship between (alkaline phosphatase + gamma-glutamyl transpeptidase)/lymphocyte ratio (AGLR) and the progression as well as the prognosis of HCC.


METHODS
A total of 495 HCC patients undergoing radical hepatectomy were retrospectively analyzed. We randomly divided these patients into the training cohort (n = 248) and the validation cohort (n = 247). In the training cohort, receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value of AGLR for predicting postoperative survival of HCC patients, and the predictive value of AGLR was evaluated by concordance index (C-index). Further analysis of clinical and biochemical data of patients and the correlation analysis between AGLR and other clinicopathological factors were finished. Univariate and multivariate analyses were performed to identify prognostic factors for HCC patients. Survival curves were analyzed using the Kaplan-Meier method.


RESULTS
According to the ROC curve analysis, the optimal predictive cut-off value of AGLR was 90. The C-index of AGLR was 0.637 in the training cohort and 0.654 in the validation cohort, respectively. Based on this value, the HCC patients were divided into the low-AGLR group (AGLR ≤ 90) and the high-AGLR group (AGLR > 90). Preoperative AGLR level was positively correlated with alpha-fetoprotein (AFP), tumor size, tumor-node-metastasis (TNM) stage, and microvascular invasion (MVI) (all p < 0.05). In the training and validation cohorts, patients with AGLR > 90 had significantly shorter OS than patients with AGLR ≤ 90 (p < 0.001). Univariate and multivariate analyses of the training cohort (HR, 1.79; 95% CI 1.21-2.69; p < 0.001) and validation cohort (HR, 1.82; 95% CI 1.35-2.57; p < 0.001) had identified AGLR as an independent prognostic factor. A new prognostic scoring model was established based on the independent predictors determined in multivariate analysis.


CONCLUSIONS
The elevated preoperative AGLR level indicated poor prognosis for patients with HCC; the novel prognostic scoring model had favorable predictive capability for postoperative prognosis of HCC patients, which may bring convenience for clinical management.
['Liao|Yan|Y|', 'Wei|Rongyu|R|', 'Yao|Renzhi|R|', 'Qin|Liling|L|', 'Li|Jun|J|', 'Yu|Junxiong|J|', 'Liao|Weijia|W|http://orcid.org/0000-0002-8906-8612']
D000328:Adult D000368:Aged D000410:Alanine Transaminase D000469:Alkaline Phosphatase D015415:Biomarkers D006528:Carcinoma, Hepatocellular D005260:Female D006498:Hepatectomy D006801:Humans D008113:Liver Neoplasms D008214:Lymphocytes D008297:Male D008875:Middle Aged D011237:Predictive Value of Tests D011379:Prognosis D012372:ROC Curve D012189:Retrospective Studies D012307:Risk Factors D005723:gamma-Glutamyltransferase
AGLR Prognosis Hepatocellular carcinoma Biomarker