* These authors contributed equally to this paper. Correspondence: Chang Liu, Professor, MD, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University College of Medicine, No.277 West Yan-ta Road, Xi’an 710061, Shaanxi Province, China. Tel: + 86 29 8265 3900. Fax: + 86 29 8265 3905. E-mail: liuchangdoctor@163.com (Received 27 May 2014; accepted 25 October 2014) ORIGINAL ARTICLE The prognostic values of 12 cirrhosis-relative noninvasive models in patients with hepatocellular carcinoma QING PANG 1 * , JING-YAO ZHANG 1 * , XIN-SEN XU 1 * , SI-DONG SONG 1 , WEI CHEN 1 , YAN-YAN ZHOU 1 , RUN-CHEN MIAO 1 , KAI QU 1 , SU-SHUN LIU 1 , YA-FENG DONG 2 & CHANG LIU 1 1 Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi Province, China, and 2 Department of Obstetrics and Gynecology , University of Kansas School of Medicine, Kansas City , KS, USA Abstract Background. Hepatocellular carcinogenesis is associated with the progression of cirrhosis, and the latter further aggravates tumor development and prognosis. The aim of the study was to investigate the prognostic values of 12 cirrhosis-relative nonin- vasive models in hepatocellular carcinoma (HCC). Methods. We retrospectively analyzed 363 HCC patients who either under- went partial hepatectomy (PH) or received transcatheter arterial chemoembolization (TCAE). Preoperative data were collected to calculate these indices using the original formulas. Diagnostic accuracy of these models in detection of cirrhosis was evalu- ated by area under receiver operating characteristic curve (AUC) analysis. Multivariate analyses were performed to assess the independent prognostic significance of the 12 indicators. Results. Aspartate aminotransferase-platelet ratio index (APRI) and Goteborg University Cirrhosis Index (GUCI) were found to be significant in discriminating cirrhotic patients from non-cirrhotic individuals. When the indices were expressed as continuous variables, multivariate analyses indicated that APRI and GUCI were independent indices to predict overall survival in patients underwent PH, with a hazard ratio (HR) value 1.04 ( p = 0.005) and 1.07 ( p = 0.001), respectively. In the cohort of TACE, APRI and GUCI were independently associated with survival as well. Conclusion. Of the 12 indices, APRI and GUCI were relatively accurate predictors of cirrhosis status as well as outcome of HCC. As only a limited study population was enrolled in the current study, larger cohorts are needed to validate our results. Key Words: Liver cirrhosis, hepatocellular carcinoma, survival, hepatectomy, blood platelets, alkaline phosphatase, gamma- glutamyltransferase Abbreviations: HCC, hepatocellular carcinoma; HBV, hepatitis B viral; HCV, hepatitis C viral; CLIP, Cancer of the Liver Italian Program; PH, partial hepatectomy; TACE, transcatheter arterial chemoembolization; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALP, alkaline phosphatase; GGT, gamma-glutamyltransferase; PLT, platelet count; INR, international normalized ratio; AFP, alpha-fetoprotein; AAR, aspartate aminotransferase/alanine aminotransferase ratio; AARP, AAR-platelet score; API, age/platelet index; CDS, cirrhosis discriminant score; APRI, AST/platelet ratio index; FibroQ, fibro-quotient; GUCI, Goteburg University Cirrhosis Index; APGA, AST/platelet/GGT/AFP index; PAPAS, platelet/age/phosphatase/AFP/AST index; AUC, areas under the receiver operating characteristic curve; ROC, receiver operating characteristic; OS, overall survival; DFS, disease-free survival; RFA, radiofrequency ablation; NBNC, non- hepatitis B non-hepatitis C. Introduction Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third most common cause of death from cancer worldwide [1]. HCC most commonly occurs secondary to the infection of hepatitis viruses, including hepatitis B viral (HBV) and hepatitis C viral (HCV). As HBV infec- tion is generally considered to be the major risk factor for cirrhosis and HCC, 80% of HCC patients occurred in areas with a high prevalence of HBV, such as Asia-Pacific and sub-Saharan Africa region [2,3]. Scandinavian Journal of Clinical & Laboratory Investigation, 2014; Early Online: 1–12 ISSN 0036-5513 print/ISSN 1502-7686 online © 2014 Informa Healthcare DOI: 10.3109/00365513.2014.981759 Scand J Clin Lab Invest Downloaded from informahealthcare.com by Nyu Medical Center on 12/29/14 For personal use only.