Can Non‑Invasive Assessment of Liver Fibrosis Serve as a Prognostic Predictor for HBV‑Related Cirrhotic Patients with Hepatocellular Carcinoma?

Purpose This study aimed to investigate the association between the aspartate aminotransferase‑to‑platelet ratio index (APRI) and postoperative prognosis in patients with hepatocellular carcinoma (HCC) complicated by liver cirrhosis. Methods Clinical data of cirrhotic HCC patients undergoing hepatectomy were retrospectively analyzed. A receiver‑operating‑characteristic (ROC) curve was constructed to identify the optimal APRI cut‑off value for prognostic prediction. Univariate prognostic analysis was performed using Kaplan‑Meier survival analysis coupled with the Log‑rank test, and multivariate analysis was conducted via Cox proportional‑hazards regression models. Survival endpoints were compared between high‑APRI and low‑APRI groups. Results ROC‑curve analysis determined the optimal APRI cut‑off value of 0.61. Patients were stratified into the high‑APRI group (APRI ≥ 0.61) and the low‑APRI group (APRI < 0.61). At the end of follow‑up, liver‑failure‑related mortality was significantly higher in the high‑APRI group (χ 2 = 5.232, P = 0.022) than in the low‑APRI group. Survival analyses revealed that maximum tumor diameter > 0.5 cm, multiple tumor lesions, liver capsule invasion, vascular tumor thrombus, alpha‑fetoprotein (AFP) > 20 ng/mL, and APRI ≥ 0.61 were independent risk factors for shortened disease‑free survival (DFS) after hepatectomy among cirrhotic HCC patients (all P < 0.05). The 1‑, 2‑, and 5‑year DFS rates were 79.4%, 61.4%, and 43.7% in the low‑APRI group versus 71.4%, 51.6%, and 27.0% in the high‑APRI group. The corresponding 1‑, 2‑, and 5‑year tumor recurrence rates were 20.5%, 38.1%, 54.1% and 28.0%, 47.1%, 69.8%, respectively (P < 0.001). Patients with portal hypertension (PH) and Child‑Pugh B liver function exhibited significantly higher APRI values than patients without PH and those with Child‑Pugh A liver function (P < 0.05). Conclusion Cirrhotic HCC patients with preoperative APRI ≥ 0.61 have an unfavorable postoperative prognosis following hepatectomy.