Abstract: Objective To investigate the effect of preoperative alkaline phosphatase to prealbumin ratio (APR) on overall survival (OS) of hepatocellular carcinoma (HCC) patients after hepatectomy. Methods The clinical data of 942 HCC patients who underwent hepatectomy in the Guangxi Medical University Cancer Hospital from January 2012 to December 2016 were retrospectively analyzed. The cut⁃off value of APR was determined by time⁃dependent receiver operating characteristic (ROC) curve.  According to the cut⁃off value, patients were divided into high APR group (APR≥cut⁃off value) and low APR group (APR Results The ROC curves showed that the area under the curve (AUC) of APR for predicting the prognosis of HCC patients at 5 years after surgery was 0.656, and the cut⁃off value of APR was 0.38 U/mg. The 1⁃, 3⁃, and 5⁃year overall survival rates of the low APR group were 90.3%, 75.5%, and 69.5%, respectively, and those of the high APR group were 76.5%, 54.5%, and 46.0%, respectively, the difference between the two groups was statistically significant (P<0.001). Multivariable Cox proportional hazards regression model analysis showed that high APR was an independent risk factor for OS in HCC patients after hepatectomy (HR=1.646, 95%CI: 1.323-2.047, P<0.001). Conclusions Preoperative high APR is an independent risk factor for prognosis of HCC patients after hepatectomy, and may be a predictor of poor prognosis in HCC patients after hepatectomy.

Key words: Hepatocellular carcinoma,  ,  , Hepatectomy,  ,  , Preoperative alkaline phosphatase to prealbumin ratio,  ,  , Overall survival