Albumin-to-alkaline phosphatase ratio: A novel prognostic index of overall survival in cholangiocarcinoma patients after surgery

Table 1 Clinicopathological characteristics of cholangiocarcinoma patients n (%)

Characteristic	Total (n = 303)
Age, yr
< 60	150 (49.5)
≥ 60	103 (50.5)
Sex
Female	135 (44.55)
Male	168 (55.46)
Infectious diseases
HBV	31 (10.23)
HCV	5 (1.65)
Serum albumin level [median (cIQ values)]	38.7 (25.0 - 49.0)
ALP [median (IQ values)]	315 (42.0 - 6778.0)
AAPR
≥ 0.41	253 (83.5)
< 0.41	50 (16.5)
Tumor size
< 3	233 (76.9)
≥ 3	70 (23.1)
Number of tumors
1	278 (91.7)
≥ 2	25 (8.3)
Curative resection	156 (51.5)
Stage (III + IV)	98 (32.3)

AAPR: Albumin-to-alkaline phosphatase ratio; HBV: Hepatitis B virus; HCV: Hepatitis C virus; CCA: Cholangiocarcinoma; ALP: Alkaline phosphatase; IQ values: Interquartile values.

Table 2 Univariate and multivariate analyses of factors in relation to overall survival

Variable	Univariate		Multivariate
	HR (95%CI)	P value	HR (95%CI)	P value
Age, yr	1.3 (0.6–2.1)	0.650
≥ 60
≥ 60
Sex	0. 98 (0.64-1.76)	0.300
Female
Male
Infectious diseases
HBV	1.85 (1.10-2.47)	P < 0.001	1.31 (1.42–1.92)	< 0.001
HCV	1.67 (0.23-12.03)	0.486
Serum albumin level, g/L	0.84 (0.59-1.21)	0.278
≥ 35
< 35
ALP, ng/mL	2.46 (0.98-6.18)	0.054
≥ 20
< 20
AAPR	3.56 (1.28-9.92)	0.035	2.88 (1.19-5.78)	0.002
≥ 0.41
< 0.41
Tumor size, cm	3.14 (1.80-6.05)	0.021	2.71 (1.72-4.79)	0.012
≥ 5
< 5
Number of tumors	2.82 (1.17-4.28)	0.013	2.30 (1.95-3.20)	< 0.001
≥ 2
1
Curative resection	0.49 (0.17-0.85)	0.007	0.35 (0.29-0.42)	0.001
Yes
No
Stage (III + IV)	2.02 (1.34–3.12)	< 0.001	1.81 (1.242.49)	< 0.001

HR: Hazard ratio; AAPR: Albumin-to-alkaline phosphatase ratio; HBV: Hepatitis B virus; HCV: Hepatitis C virus; CCA: Cholangiocarcinoma; ALP: Alkaline phosphatase.

Table 3 Univariate and multivariate analyses of factors in relation to recurrence free survival

Variable	Univariate		Multivariate
	HR (95%CI)	P value	HR (95%CI)	P value
Age, yr	1.31 (0.89-2.91)	0.381
≥ 60
≥ 60
Sex	1.0 (0.5–1.8)	0.300
Female
Male
Infectious diseases
HBV	1.91 (0.73-5.21)	0.212
HCV	2.45 (0.61–5.21)	0.374
Serum albumin level, g/L	0.89 (0.34-2.34)	0.171
≥ 35
< 35
ALP, ng/mL	1.96 (0.73–5.32)	0.212
≥ 20
< 20
AAPR	2.52 (1.38–4.75)	0.002	2.31 (1.40–3.29)	< 0.001
≥ 0.41
< 0.41
Tumor size, cm	3.62 (1.73–7.69)	0.010	1.92 (1.70–2.16)	< 0.001
≥ 5
< 5
Number of tumors	2.47 (1.21–5.23)	0.009	2.20 (1.41–4.87)	0.002
≥ 2
1
Stage (III + IV)	2.73 (1.81–3.55)	0.003	2.32 (1.26–3.53)	< 0.001

HR: Hazard ratio; AAPR: Albumin-to-alkaline phosphatase ratio; HBV: Hepatitis B virus; HCV: Hepatitis C virus; CCA: Cholangiocarcinoma; ALP: Alkaline phosphatase.