Alcohol-related cancer morbidity and mortality are stratified using modified albumin platelet product

Abstract

Alcohol abuse is associated with several diseases, such as hepatocellular carcinoma, cirrhosis, and extrahepatic malignancies. Recently, we reported albumin platelet product (APP) and modified APP (mAPP) as novel indices of liver fibrosis staging and prognosis in patients without alcoholic liver diseases. This retrospective cohort study aimed to extend application of APP and mAPP in prognosis prediction of patients with alcoholic liver diseases. We enrolled 222 patients with alcoholic liver diseases based on their medical records. Cut-off values of APP = 4.349 and mAPP = 2.484 were adopted based on a past report. Hazard ratios of APP and mAPP were compared to those of albumin-bilirubin score and fibrosis-4 index. The primary and secondary endpoints were carcinogenesis and death, respectively. Thus, APP = 4.349 and mAPP = 2.484 significantly differentiated cancer-free survival and overall survival in univariate analysis. Hazard ratios of mAPP = 2.484 were greater than those of the albumin-bilirubin score of -2.270 and fibrosis-4 index of 3.25. Multivariate analysis revealed mAPP = 2.484 as an independent risk factor for carcinogenesis and overall death. In conclusion, mAPP is a simple index to stratify patient's risk for carcinogenesis and death.

Figure 1

Cancer-free survival evaluated using APP and mAPP. A univariate analysis was performed to evaluate the prognostic potential of APP and modified APP (mAPP) for cancer-free survival. APP = 4.349 and mAPP = 2.484 were adopted as cut-off values. (a) APP = 4.349 significantly differentiates the cancer-free survival of patients with alcoholic liver diseases with an HR of 2.207 (P = 0.0031). (b) mAPP was able to predict the prognosis of the patients with a better HR of 2.627 than that of APP (P = 0.0002). HCC, hepatocellular carcinoma; HR, hazard ratio; mAPP, modified albumin platelet product.

Figure 2

HCC-free survival stratified using APP and mAPP. Focusing on hepatocellular carcinoma (HCC), differentiation of HCC-free survival was tested using APP and modified APP (mAPP). Both patients with APP > 4.349 (HR, 2.184; P = 0.0111) (a) and with mAPP > 2.484 (HR, 2.563; P = 0.0017) (b) showed a better overall survival compared to others. The hazard ratios were better for mAPP than for APP. HCC, hepatocellular carcinoma; HR, hazard ratio; mAPP, modified albumin platelet product.

Figure 3

Overall survival evaluated using APP and mAPP. The prognostic potential of APP and modified APP (mAPP) for overall survival was determined using univariate analysis. (a) Patients with APP > 4.349 presented a better overall survival compared to those of patients with APP < 4.349 with an HR of 2.596 (P = 0.0074). (b) An HR of mAPP = 2.484 (3.478; P = 0.0004) for overall survival was better than that of APP = 4.349. APP, albumin platelet product; APP, albumin platelet product; HCC, hepatocellular carcinoma; HR, hazard ratio; mAPP, modified albumin platelet product.