To evaluate the prognostic value of preoperative serum alkaline phosphatase-to-albumin ratio (APAR) for patients with hepatocellular carcinoma (HCC) after radical hepatectomy.

Clinical data of 296 HCC patients who underwent radical hepatectomy in the Affiliated Hospital of North Sichuan Medical College from January 2015 to December 2019 were retrospectively analyzed. Among them, 257 patients were male and 39 female, aged (56±11) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. The optimal cut-off value of APAR was determined by the receiver operating characteristic (ROC) curve. The clinicopathological features of the high and low APAR groups were compared and the relationship between APAR and postoperative survival was analyzed. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The prognostic factors of HCC patients after radical resection were identified by Cox's proportional hazards regression model.

All patients were divided into the high APAR group (n=136) and low APAR group (n=160) according to the optimal cut-off value of APAR 3.38. The postoperative 1-, 3- and 5-year disease-free survival in high APAR group were 49.4%, 20.0%, and 5.1%, respectively and were 78.6%, 42.7%, 13.5% in low APAR group, the disease-free survival in low APAR group was significantly better than that in high APAR group (χ²=44.485, P<0.05). Cox's multivariate analysis showed that APAR≥3.38 U/g wasan independent risk factor for the disease-free survival of HCC patients after radical resection (HR=1.788, 95%CI: 1.241-2.577, P<0.05).

Preoperative APAR is an independent prognostic factor for HCC patients after radical hepatectomy. Patients with low APAR have better disease-free survival than those with high APAR.