Prognostic significance of APRI index and neutrophil/lymphocyte ratio in hepatocellular carcinoma patients undergoing liver transplantation

Abstract

Aim: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Liver transplantation (LT) is the only curative treatment that eliminates both the cirrhotic liver and the cancer. Our study aimed to demonstrate the ability of systemic and local inflammatory factors to predict prognosis and long-term survival outcomes for LT. Materials and Methods: We analyzed 220 patients undergoing LT for HCC in two separate transplant centers between January 2012 and December 2024. The primary objectives were overall survival (OS), recurrence-free survival (RFS), and recurrence risk. Results: The optimal cutoff values for neutrophil to lymphocyte ratio (NLR) and aspartate aminotransferase/platelet count ratio index (APRI) for OS and RFS were 0.451 and 0.68, respectively. We showed that the APRI > 0.68 (high) group had significantly better overall survival outcomes for RFS and OS. Borderline significance was observed in OS for the NLR > 4.51 group. In particular, tumor size and tumor number were found to be significant factors negatively affecting survival. Discussion: We determined that a high systemic NLR level was useful for predicting OS, but this was not significant for recurrence or RFS. It is not a useful systemic inflammatory index for screening patients undergoing LT at high risk of recurrence. In our study, a high APRI score was associated with an increased mortality rate. Conversely, a high APRI score was associated with a better RFS. We found that a high APRI value was associated with a better OS.