Multivariate Analysis Of Preoperative ALBI,APRI And ANRI On The Prognosis Of Liver Cancer Patients Treated With TACE

Objective: The aim of the study was to explore the risk factors of preoperative albumin-bilirubin(ALBI)score,aspartate aminotransferase to platelet ratio index(APRI)and aspartate aminotransferase to neutrophil ratio index(ANRI)in patients with liver cancer after receiving transcatheter arterial chemoembolization(TACE),and to provide valuable reference for optimizing the clinical treatment of advanced liver cancer.Methods: A total of 144 patients diagnosed with liver cancer and underwent TACE for the first time in the Affiliated Hospital of Youjiang Medical College for Nationalities from January 1,2016 to August 31,2020 were retrospectively analyzed.All patients were followed up until January 01,2021.The general data and clinical data of the patients were collected.According to the preoperative blood indicators,the ALBI was divided into grade 1,2 and 3 by ALBI grading calculation formula.The optimal cut-off values of ALBI,APRI and ANRI were determined according to the ROC of preoperative ALBI,APRI and ANRI.Patients were divided into high ALBI group and low ALBI group,high APRI group and low APRI group,high ANRI group and ANRI group,and general clinical data of patients with different levels of ALBI in APRI group and ANRI group were compared.SPSS 26.0 software was used for statistical analysis,chi-square test(X2 test)was used for enumeration data.Kaplan-Meier method was used for univariate analysis of survival data.Log-Rank method was used for test.P<0.05 was considered statistically significant.After univariate analysis,statistically significant variables were included in the Cox multivariate proportional hazards model to determine independent survival predictors,and the difference was statistically significant at P<0.05.The combined ROC curves of ALBI-APRI combined,ALBI-ANRI combined,and APRI-ANRI were depicted and compared with the ROC curves of ALBI,APRI,and ANRI to compare their predictive value,and those with higher predictive value were subjected to Kaplan-Meier univariate survival analysis.Results:(1)The mean survival of 144 patients was 13.3 ±1.5 months,median survival time was 10±1.9 months,and the number of deaths was 100 as of the follow-up date of January 1,2021.119 patients(82.6%)had history of hepatitis B,57 patients(39.6%)had cirrhosis,and 64 patients(39.6%)had cirrhosis,and the overall survival rate at 1 year after TACE was 30.1%.(2)the ROC curve results showed that preoperative ALBI =-2.225,APRI =0.865,and ANRI = 15.635 were the optimal cut-off values.(3)Clinical data of patients with low ALBI,APRI,ANRI and high ALBI,APRI,ANRI before surgery were compared,and the effects on the prognosis of TACE treatment were history of hepatitis B,ALT,AST,ALP,CHE,γ-GT,albumin,bilirubin,ascites,cirrhosis,oral targeted drugs,single TACE therapy(P<0.05),in addition,different levels of ALBI had an impact on the prognosis of TACE treatment.TACE combined with MWA and particle implantation(P< 0.05),different levels of APRI have an impact on the prognosis of TACE treatment and TACE combined with MWA(P<0.05).(4)Kaplan-Meier univariate analysis was performed for the general clinical data of patients,and Log-Rank method was used for testing.The results showed that drinking history,family history,ascites,tumor thrombus,oral targeted drugs,ALT,AST,ALP,γ-GT,AFP,PT,total bilirubin,albumin,single TACE therapy,multiple TACE therapies,TACE combined with MWA and particle implantation therapy,ALBI,APRI,ANRI were the factors affecting the prognosis of liver cancer after TACE(P< 0.05),the OS of patients in the ALBI <-2.225 group was higher than that in the ALBI ≥-2.225 group,the OS of patients in the APRI≤0.865 group was higher than that in the APRI > 0.865 group,and the OS of patients in the ANRI≤15.635 group was higher than that in the ANRI >15.635 group.The results of Cox multi-factor analysis showed that AFP and ALBI were independent risk factors affecting the prognosis of TACE in patients with liver cancer(P<0.05),and TACE combined with MWA and particle implantation was independent protective factors affecting the postoperative prognosis of TACE in patients with liver cancer(P<0.05).(5)The area under the curve(AUC)was greater when ALBI-APRI was combined and APRI-ANRI was combined compared with ALBI,APRI,and ANRI alone.(6)The median survival time of patients in the preoperative ALBI grade 1-low ANRI group was significantly longer than that of patients in the ALBI2grade-low ANRI group,ALBI grade 3-low ANRI group,ALBI grade 1-high ANRI group,ALBI2 grade-high ANRI group,and ALBI grade 3-high ANRI group.The median survival time of patients in the low ALBI group-low ANRI group was significantly longer than that of patients in the low ALBI group-high ANRI group,high ALBI group-low ANRI group,and high ALBI group-high ANRI group.The median survival time of patients in the low APRI group-low ANRI group was significantly longer than that of patients in the low APRI group-high ANRI group,high APRI group-low ANRI group,and high APRI group-high ANRI group,and the differences were statistically significant(P< 0.001).Conclusion:(1)There are many factors affecting the prognosis of TACE in liver cancer;AFP and ALBI are independent risk factors affecting the prognosis of patients with liver cancer after TACE;TACE combined with MWA and particle implantation therapy is independent protective factors affecting the prognosis of TACE in patients with liver cancer.(2)ALBI,APRI and ANRI values affect the prognosis of TACE therapy for liver cancer.The median survival time and cumulative survival rate of ALBI grade 1 patients are higher than those of ALBI grade 2 and ALBI grade 3 patients,and the prognosis of low APRI and ANRI groups is better than that of high APRI and ANRI groups.(3)ALBI,APRI and ANRI have predictive value for the prognosis of liver cancer patients after TACE;The combination of ALBI-APRI and APRI-ANRI has better prognostic value compared with ALBI,APRI and ANRI.