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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Trends of alkaline phosphatase to prealbumin ratio in patients with hepatitis B linked to hepatocellular carcinoma development
Wen-Chong Zhen, Jing Sun, Xue-Ting Bai, Qian Zhang, Zi-Han Li, Yi-Xin Zhang, Rong-Xuan Xu, Wei Wu, Zhi-Han Yao, Chun-Wen Pu, Xiao-Feng Li
Wen-Chong Zhen, Xue-Ting Bai, Qian Zhang, Zi-Han Li, Yi-Xin Zhang, Rong-Xuan Xu, Wei Wu, Zhi-Han Yao, School of Public Health, Dalian Medical University, Dalian 116044, Liaoning Province, China
Jing Sun, Graduate School, Dalian Medical University, Dalian 116044, Liaoning Province, China
Chun-Wen Pu, Dalian Public Health Clinical Center, Dalian Municipal Research Institute for Public Health, Dalian 116001, Liaoning Province, China
Xiao-Feng Li, Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian 116044, Liaoning Province, China
Co-first authors: Wen-Chong Zhen and Jing Sun.
Co-corresponding authors: Chun-Wen Pu and Xiao-Feng Li.
Author contributions: Zhen WC and Sun J contribute equally to this study as co-first authors; Pu CW and Li XF contribute equally to this study as co-corresponding authors; Zhen WC and Li XF designed the study and drafted the initial manuscript; Sun J participated in the statistical analysis and interpretation of the data; Bai XT, Zhang Q, Li ZH, Zhang XY, Xu RX, Wu W, Yao ZH participated in the acquisition, analysis; Pu CW Provided clinical data, Li XF performed the review and editing.
Institutional review board statement: The study was reviewed and approved by the Dalian Public Health Clinical Center Institutional Review Board (Approval No. 2024-026KY-001).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this research hereby confirm that there are no potential conflicts of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Xiao-Feng Li, PhD, Professor, Department of Epidemiology and Health Statistics, Dalian Medical University, No. 9 West Section Lvshun Road, Dalian 116044, Liaoning Province, China.
lxf_chen@dmu.edu.cn
Received: July 20, 2024
Revised: October 25, 2024
Accepted: November 18, 2024
Published online: January 14, 2025
Processing time: 150 Days and 19.9 Hours
BACKGROUND
Chronic hepatitis B often progresses silently toward hepatocellular carcinoma (HCC), a leading cause of mortality worldwide. Early detection of HCC is crucial, yet challenging.
AIM
To investigate the role of dynamic changes in alkaline phosphatase to prealbumin ratio (APR) in hepatitis B progression to HCC.
METHODS
Data from 4843 patients with hepatitis B (January 2015 to January 2024) were analyzed. HCC incidence rates in males and females were compared using the log-rank test. Data were evaluated using Kaplan–Meier analysis. The Linear Mixed-Effects Model was applied to track the fluctuation of APR levels over time. Furthermore, Joint Modeling of Longitudinal and Survival data was employed to investigate the temporal relationship between APR and HCC risk.
RESULTS
The incidence of HCC was higher in males. To ensure the model’s normality assumption, this study applied a logarithmic transformation to APR, yielding ratio. Ratio levels were higher in females (t = 5.26, P < 0.01). A 1-unit increase in ratio correlated with a 2.005-fold higher risk of HCC in males (95%CI: 1.653-2.431) and a 2.273-fold higher risk in females (95%CI: 1.620-3.190).
CONCLUSION
Males are more prone to HCC, while females have higher APR levels. Despite no baseline APR link, rising APR indicates a higher HCC risk.
Core Tip: Joint Modeling of Longitudinal and Survival data analysis revealed no association between baseline alkaline phosphatase to prealbumin ratio (APR) levels and Hepatocellular carcinoma (HCC) risk, yet a significant correlation exists between the increasing trend of APR and heightened HCC risk.
