Aspartate aminotransferase-to-platelet ratio index for predicting late recurrence of hepatocellular carcinoma after radiofrequency ablation

Figures & data

Figure 1. Flowchart for the patient selection and study design.

Table 1. Patient demographics of primary cohort.

Characteristics	Total patients	No late recurrence	Late recurrence	p Value
N	466	382 (82.0%)	84 (18.0%)
APRI				<0.001
APRI ≤ 0.78	314	301 (78.8%)	13 (15.5%)
APRI > 0.78	152	81 (21.2%)	71 (84.5%)
Gender				<0.001
Female	225	215 (56.3%)	10 (11.9%)
Male	241	167 (43.7%)	74 (88.1%)
Age (years)				0.743
≤65	354	305 (79.8%)	69 (82.1%)
>65	92	77 (20.2%)	15 (17.9%)
Max size (cm)				0.518
≤2.0	214	195 (51.0%)	39 (46.4%)
>2.0	232	187 (49.0%)	45 (53.6%)
Number				0.015
Solitary	238	222 (58.1%)	36 (42.9%)
Multiple	208	160 (41.9%)	48 (57.1%)
Etiology				0.134
None	30	29 (7.6%)	1 (1.2%)
Viral hepatitis	387	312 (81.7%)	75 (89.3%)
Alcoholic hepatitis	46	39 (10.2%)	7 (8.3%)
NAFLD	3	2 (0.5%)	1 (1.2%)
Cirrhosis				0.055
No	10	29 (7.6%)	1 (1.2%)
Yes	436	353 (92.4%)	83 (98.8%)
Child-Pugh class				0.241
A	427	364 (95.3%)	83 (98.8%)
B	19	18 (4.7%)	1 (1.2%)
ALBI grade				0.616
1	242	204 (53.4%)	48 (57.1%)
2	204	178 (46.6%)	36 (42.9%)
AFP (ng/mL)				0.511
≤400	401	343 (89.8%)	78 (92.9%)
>400	45	39 (10.2%)	6 (7.1%)
ALB (g/L)				0.087
≤35	43	57 (14.9%)	6 (7.1%)
>35	403	325 (85.1%)	78 (92.9%)
AST (U/L)				0.636
≤40	357	307 (80.4%)	70 (83.3%)
>40	89	75 (19.6%)	14 (16.7%)
ALT (U/L)				0.562
≤40	90	90 (23.6%)	20 (23.8%)
>40	356	292 (76.4%)	64 (76.2%)
PLT (10^9/L)				0.809
≤100	177	160 (41.9%)	37 (44.0%)
>100	269	222 (58.1%)	47 (56.0%)
TBIL (μmol/L)				0.873
≤17.1	272	240 (62.8%)	52 (61.9%)
>17.1	174	142 (37.2%)	32 (38.1%)
γ-GT (U/L)				0.752
≤60	299	262 (68.6%)	57 (67.9%)
>60	147	120 (31.4%)	27 (32.1%)

Table 2. Cox regression analyses of clinical risk factors for late recurrence in the primary cohort.

Variables (RFS)	Univariate analysis			Multivariate analysis
	HR	95% CI	p Value	HR	95% CI	p Value
APRI
APRI ≤ 0.78
APRI > 0.78	10.160	5.622-18.380	<0.001	6.221	3.316-11.671	<0.001
Gender
Female	6.152	3.175-11.92	<0.001	2.889	1.448-5.764	0.003
Male
Age (years)
≤65	1.279	0.731-2.240	0.389	NA	NA	NA
>65
Max size (cm)
≤2.0	1.068	0.695-1.640	0.764	NA	NA	NA
>2.0
Number
Solitary	3.100	2.005-4.793	<0.001	1.720	1.099-2.691	0.018
Multiple
Etiology
None	4.642	0.645-33.420	0.127	NA	NA	NA
Viral hepatitis
Alcoholic hepatitis	4.179	0.513-34.032	0.181	NA	NA	NA
NAFLD	6.974	0.434-112.082	0.170	NA	NA	NA
Cirrhosis
No	4.620	0.642-33.221	0.128	NA	NA	NA
Yes
Child-Pugh class
A
B	0.508	0.071-3.662	0.502	NA	NA	NA
ALBI grade
1
2	0.943	0.611-1.456	0.790	NA	NA	NA
AFP (ng/mL)
≤400
>400	0.835	0.363-1.916	0.670	NA	NA	NA
ALB (g/L)
≤35
>35	1.594	0.694-3.661	0.272	NA	NA	NA
AST (U/L)
≤40
>40	0.681	0.383-1.211	0.191	NA	NA	NA
ALT (U/L)
≤40
>40	1.451	0.874-2.407	0.150	NA	NA	NA
PLT (10^9/L)
≤100	0.790	0.874-2.407	0.285	NA	NA	NA
>100
TBIL (μmol/L)
≤17.1
>17.1	0.990	0.636-1.538	0.962	NA	NA	NA
γ-GT (U/L)
≤60
>60	1.305	0.825-2.065	0.255	NA	NA	NA

Figure 2. Kaplan–Meier curve for the RFS (a) and OS (b) of patients between low-risk and high-risk groups. RFS, recurrence-free survival; OS, overall survival.

Figure 3. The nomogram for predicting the three-, four- and five-year RFS after RFA. RFS, recurrence-free survival; RFA, radiofrequency ablation.

Figure 4. The t-ROC of the nomogram for predicting the three-year (a), four-year (b) and five-year (c) RFS in patients with HCC after RFA. t-ROC, time-dependent receiver operating characteristic curve; RFS, recurrence-free survival; HCC, hepatocellular carcinoma; RFA, radiofrequency ablation.

Figure 5. The calibration curves for predicting the three-, four- and five-year RFS in patients with HCC after RFA. RFS, recurrence-free survival; HCC, hepatocellular carcinoma; RFA, radiofrequency ablation.

Figure 6. Kaplan–Meier curve for the RFS (a) and OS (b) of patients between low-risk and high-risk groups in the external validation cohort. RFS, recurrence-free survival; OS, overall survival.

Figure 7. The t-ROC of the nomogram for predicting the three-year (a), four-year (b) and five-year (c) RFS in the external validation cohort. t-ROC, time-dependent receiver operating characteristic curve; RFS, recurrence-free survival.

Figure 8. The calibration curves for predicting the three-, four- and five-year RFS in the external validation cohort. RFS, recurrence-free survival.