Predictive value of the FIB-4 index, APRI, ALBI score, and GPR for overall survival in treatment-naïve metastatic colorectal cancer patients

Predictive value of the FIB-4 index, APRI, ALBI score, and GPR for overall survival in treatment-naïve metastatic colorectal cancer patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Predictive value of the FIB-4 index, APRI, ALBI score, and GPR for overall survival in treatment-naïve metastatic colorectal cancer patients Mehmet Serdar YILDIRIM, Yunus GÜZEL, Canan CAN, İhsan KAPLAN, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5289132/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Feb, 2025 Read the published version in BMC Gastroenterology → Version 1 posted 4 You are reading this latest preprint version Abstract Background: The prevalence of metastatic colorectal cancer (mCRC) is increasing and is linked to poor overall survival (OS). Previous studies have aimed to determine the predictive value of scores and laboratory tests for OS in mCRC patients, but their findings have been inconclusive. In this research, we focused on determining the prognostic significance of the fibrosis-4 (FIB-4) index, the aspartate aminotransferase (AST) to platelet (PLT) ratio index (APRI), the albumin–bilirubin (ALBI) score, and the gamma-glutamyl transpeptidase to PLT ratio (GPR) with respect to OS in treatment-naïve mCRC patients. Methods: This retrospective study included treatment-naïve mCRC patients. The FIB-4 index, ALBI score, APRI, and GPR were calculated for each participant, and their mortality dates were recorded. The clinical importance of these scores for survival outcomes was evaluated via the Cox regression model, Kaplan–Meier method, and log-rank test. Results: The study enrolled 123 untreated mCRC patients. Univariate Cox regression analysis demonstrated that sex and AST/PLT and ALT/PLT counts were not associated with OS (p>0.05 for all). However, a higher FIB-4 index (p=0.025), ALBI score (p<0.001), GPR (p<0.001), and AST/ALT ratio (p<0.001) were all associated with poor OS. Additionally, multivariate Cox regression analysis indicated that age (95% CI: 1.009–1.053, p=0.006), ALBI score (95% CI: 1.234–2.983, p=0.004), GPR (95% CI: 1.442–2.701, p<0.001), and AST/ALT (95% CI: 1.193–2.911, p = 0.006) were independent prognostic factors for OS. Conclusion: The affordable and easily accessible ALBI score, GPR, and AST/ ALT have prognostic value in untreated patients with mCRC. Colorectal neoplasms Survival Predictive value of tests Organ dysfunction scores BACKGROUND In recent years, the prevalence of colorectal cancer (CRC) has significantly increased among both men and women and is leading to cancer-related fatalities. 1 Approximately 20% of individuals diagnosed with CRC have metastatic disease at their time of diagnosis. 2 In addition to the liver, regional lymph nodes, the lungs, and the peritoneum could be listed as the most prevalent metastasis sites for CRC. 2 The liver, the leading site for distant organ metastasis in CRC patients, determines patient survival time. 3 Although surgical resection can provide a 5-year survival rate for approximately two-thirds of patients, only 10–20% of those with CRC with liver metastases are eligible for surgery. 2 The main goal in treating metastatic CRC (mCRC) is to provide patient with an optimal quality of life for the longest possible time. 3 Therefore, clinicians should consider factors such as tumor stage and size, underlying liver functions, and the patient performance status. In recent years, increasing interest has been in determining predictive biomarkers for numerous cancers via serologic and hematologic tests 4 . A decline in liver function among CRC patients affects the prognosis of the disease. 5 The albumin–bilirubin (ALBI) score indicates the severity of liver dysfunction. 4 , 6 The aspartate aminotransferase (AST)-to-platelet (PLT) ratio index (APRI), the fibrosis-4 (FIB-4) index and the gamma-glutamyl transpeptidase (GGT)-to-PLT ratio (GPR) are significantly associated with liver fibrosis. 7 – 9 This retrospective study focused on determining the prognostic significance of scores and markers derived from biochemical tests and hemogram parameters such as the FIB-4 index, ALBI score, APRI, and GPR, on OS in CRC patients with liver metastasis who had not previously received any systemic chemotherapy or local ablative therapy or who had undergone surgery, as detected during the staging process via [18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ( 18 FDG-PET/CT) imaging. METHODS This retrospective study enrolled newly diagnosed CRC patients with liver metastases confirmed via 18 FDG PET/CT; these patients had no distant metastases other than those in the liver or lymph nodes, had not undergone surgery, and had not received any systemic chemotherapy or local ablative therapy, and received at least one course of chemotherapy after imaging between 01/01/2017 and 01/05/2023. Twenty-seven patients whose data were unavailable or who had additional malignancies were excluded. Age, sex, and biochemical liver tests and hemogram parameters were retrieved for each patient. The ALBI score, FIB-4 index, and APRI were determined via the following formulas: (I) ALBI score = (log 10 bilirubin (µmol/L) × 0.66) + (albumin (g/L) × −0.0852), (II) FIB-4 index = (age (years) x AST (U/L)) / (PLT (10 9 /L]) x (ALT (U/L) 1/2 ), and (III) APRI = [(AST level (IU/L)/ AST (upper limit of normal) (IU/L) /PLT count (109/L)] × 100. 6,8,10 Furthermore, the GPR, a fibrosis-related parameter, and the inflammatory parameters AST/PLT, ALT/PLT, and AST/ALT ratios were calculated from biochemical liver tests and hemogram data. 9 The dates of death of the patients were noted. The local ethics committee granted approval for the study protocol (approval date and number: 2024 − 111). Because the study was retrospective, participants were not asked to provide written informed consent when enrolled. All procedures were conducted according to the Good Clinical Practices Guidelines set by the Turkish Medicine and Medical Devices Agency and the Declaration of Helsinki. Statistical analysis was performed via SPSS (IBM Corporation, Armonk, New York, United States) version 26.0. The Kaplan–Meier test (product limit method) and log-rank analysis were used to investigate the impacts of factors on mortality and survival. To measure the effects of prognostic variables on mortality and survival, univariate and multivariate Cox regression analyses were performed via the Enter method. Quantitative variables are expressed as the mean ± standard deviation and median (25th/75th percentile), whereas categorical variables are expressed as n (%). Variables were analyzed at the 95% confidence level, and p < 0.05 was considered statistically significant. RESULTS One hundred twenty-three patients with mCRC who had not received prior treatment were included. The median age was 59 (17–92) years, and 56.1% (n = 69) of the participants were male. No statistically significant difference was observed in terms of sex between survivors and nonsurvivors (p > 0.05). The overall mortality rate was 85.4% (n = 105), and the median OS was 20.1 (min-max: 1-104) months (Table 1 ). Table 1 presents the participants' age, baseline scores, and laboratory findings. Table 1 Age, baseline scores and laboratory findings of the participants. Alive Exitus Total N Median Min-Max N Median Min-Max N Median Min-Max Age 18 50.50 23.0–79.00 105 59.00 17.0–92.00 123 59.00 17.0–92.00 Albumin 15 3.70 2.70–4.6 93 3.80 1.80–4.8 108 3.80 1.80–4.80 Total Bilirubin 16 0.37 0.170–2.3 100 0.58 0.100–17.6 116 0.57 0.100–17.60 ALBI score 14 -2.61 -3.60- -1.24 89 -2.57 -3.50- -0.07 103 -2.57 -3.60- -0.07 AST 18 23.00 7.0–87.00 105 23.00 10.0-2135.00 123 23.00 7.0-2135.0 ALT 18 26.00 8.0–77.00 105 17.00 6.0-1129.00 123 17.00 6.0-1129.0 ALP 7 92.00 66.0-573.00 62 122.00 43.0-672.00 69 122.00 43.0-672.0 GGT 10 20.00 13.0-344.00 68 53.50 10.0-1475.00 78 49.00 10.0-1475.0 PLT 18 288.50 177.0-693.00 105 282.00 88.0-667.00 123 282.00 88.0-693.0 INR 11 1.26 1.16–1.47 70 1.18 0.99–1.98 81 1.19 0.99–1.98 FIB-4 Index 18 1.04 0.11–2.27 105 1.25 0.25–26.18 123 1.22 0.11–26.18 AST to PLT 18 0.11 0.01–0.30 105 0.09 0.02–4.44 123 0.09 0.01–4.44 ALT to PLT 18 0.09 0.01–0.30 105 0.07 0.01–2.35 123 0.07 0.01–2.35 GGT to PLT 10 0.09 0.02–1.17 68 0.23 0.02–4.79 78 0.21 0.02–4.79 AST to PLT 18 1.11 0.48–2.09 105 1.38 0.51–4.15 123 1.32 0.48–4.15 ARPI 18 0.31 0.03–0.85 105 0.26 0.06–12.68 123 0.26 0.03–12.68 OS 18 56.13 4-97.40 105 18.23 1-103.63 123 20.17 1-104 N: Number; Min: Minimum; Max: Maximum; ALBI score: Albumin–bilirubin score; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; GGT: Gamma-glutamyl transpeptidase; PLT: Platelet; INR: International normalized Ratio; FIB-4: Fibrosis-4 index; APRI: AST to platelet ratio index; OS: Overall survival Univariate Cox regression analysis revealed that sex, AST/PLT, and ALT/PLT were not significantly associated with OS (p > 0.05 for all). On the other hand, the FIB-4 index (p = 0.025), ALBI score (p < 0.001), GPR (p < 0.001), and AST/ALT ratio (p < 0.001) were associated with poor OS (Table 2 ). The multivariate Cox regression analysis demonstrated that age (95% CI: 1.009–1.053, p = 0.006), ALBI score (95% CI: 1.234–2.983, p = 0.004), AST/ALT (95% CI: 1.193–2.911, p = 0.006), and GPR (95% CI: 1.442–2.701, p < 0.001) were independent prognostic factors for OS, as summarized in Table 2 . Table 2 Univariate and multivariate Cox regression analyses. Univariate analysis Multivariate analysis B OR 95% CI p B OR 95% CI p Lower Upper Lower Upper Age 0.012 1.012 0.999 1.026 0.080 0.030 1.031 1.009 1.053 0.006 ALBI score 0.767 2.153 1.556 2.977 0.000 0.652 1.919 1.234 2.983 0.004 FIB-4 Index 0.063 1.065 1.008 1.125 0.025 -0.022 0.979 0.901 1.063 0.607 AST to PLT 0.287 1.332 0.918 1.932 0.131 ALT to PLT 0.363 1.437 0.639 3.234 0.381 GGT to PLT 0.572 1.772 1.343 2.339 0.000 0.680 1.973 1.442 2.701 0.000 AST to ALT 0.574 1.775 1.371 2.299 0.000 0.623 1.864 1.193 2.911 0.006 APRI 0.100 1.106 0.971 1.259 0.131 Gender 0.086 1.090 0.739 1.607 0.664 CI: Confidence interval; OR: Odds ratio; ALBI score: Albumin–bilirubin score; FIB-4: Fibrosis-4 index; PLT: Platelet; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; GGT: Gamma-glutamyl transpeptidase; APRI: AST to platelet ratio index; OS: Overall survival DISCUSSION The results of this study revealed that age, the ALBI score, the AST/ALT ratio, and the GPR are independent prognostic factors for OS among untreated de novo mCRC patients. The objectives of treating mCRC are to increase patient quality of life for as long as possible and improve survival. Seth et al. reported that patients with CRC and liver metastases who underwent resection had a 5-year survival rate of approximately 35%. 3 The outcome for individuals who underwent liver resection can be predicted before the surgery. The ALBI score is useful for objectively evaluating liver function. 6 A decrease in the albumin level indicates liver synthesis dysfunction, leading to a decrease in the ALBI score. 6 The ALBI score was first employed in patients with a diagnosis of hepatocellular carcinoma (HCC), and it has been noted as a cost-effective, straightforward, and impartial approach to evaluating liver function and as a predictive element in individuals with primary biliary cirrhosis or HCC. 6 , 9 , 11 Several subsequent studies have suggested that the ALBI score serves as a prognostic indicator for individuals diagnosed with breast, gastric, or pancreatic cancer. 12 – 14 A study by Koh et al. on stage 1–3 CRC patients revealed that the ALBI score was associated with progression-free survival via both univariate and multivariate analyses. 15 Additionally, high ALBI scores and age are linked to disease-free survival and OS. 15 In a different study, two randomized trials involving patients with stage 4 CRC were combined, and the ALBI score and age were found to be independent prognostic factors. 16 In our study, we found that the ALBI score was linked to survival when patients were examined individually. When we conducted a multivariate analysis, we discovered that age and ALBI score independently influenced overall survival, suggesting that our findings aligned with prior research. Regardless of its etiology, in chronic liver diseases, parenchymal injury progresses through a dynamic process that involves ongoing activation of the inflammatory response, continuous activation of liver fibrogenesis, and a wound healing response marked by the excessive buildup of extracellular matrix components by hepatic myofibroblasts. 17 After initial reports on the importance of liver fibrosis in various types of hepatitis, several studies on mCRC patients reported that those with high liver fibrosis scores had a higher prevalence of liver metastases and recurrence than those with low liver fibrosis scores did. 8 , 18 Lemoine and colleagues proposed that the GPR provides more precise results than the APRI and FIB-4 index for detecting liver fibrosis in individuals with chronic hepatitis B. 19 The combination of liver function and coagulation status is objectively reflected by the GPR. 20 There is increasing evidence that the GPR independently predicts the outcome of different types of cancer. 20 , 21 Ma et al. conducted a meta-analysis involving 1,952 patients and reported that the GPR has favorable accuracy, sensitivity, and prognostic value in patients with HCC. 22 Nevertheless, we found no studies on CRC in the literature. Both univariate and multivariate analyses in the current study revealed that the GPR was an independent prognostic factor for predicting OS. The degree of hepatocellular damage is associated with increased serum levels of ALT and AST. 23 The ratio of AST to ALT is a biomarker that indicates liver function impairment and can be measured noninvasively. It has been utilized to evaluate the progression of fibrosis in liver diseases including nonalcoholic fatty liver disease (NAFLD). 23 The AST-to-ALT ratio has recently been demonstrated to act as a prognostic indicator for different types of cancer in recent times. 24 , 25 A study involving CRC patients revealed that higher AST levels and age were correlated with survival. 26 Moreover, in a study enrolling 536 stage 2–3 CRC patients, Scheipner et al. reported a potential decline in OS associated with a higher AST/ALT ratio. 27 However, univariate and multivariate analyses did not indicate a statistically significant correlation. 27 In the present study, which included stage 4 CRC patients, the ratio of AST to ALT was determined to be a standalone prognostic indicator for OS via both univariate and multivariate analyses (p < 0.001, and p = 0.006, respectively). The FIB-4 index, another noninvasive and inexpensive method for evaluating the extent of fibrosis in the liver, has been used in individuals with long-term liver disease, particularly hepatitis C virus. 7 , 10 NAFLD might be linked to increased liver metastasis. Studies using the FIB-4 index as an indicator of steatosis severity and evaluating the mechanisms associated with metastasis in CRC patients with NAFLD are limited. Patients with CRC may experience a decrease in simultaneous liver metastasis when they have advanced fibrosis in the liver due to NAFLD. 28 The frequency of NAFLD is rapidly increasing on a global scale; therefore, it is crucial for subsequent clinical studies involving CRC patients to focus on the incidence of NAFLD in different populations. To our knowledge, the effect of the FIB-4 index on prognosis in mCRC patients has not been studied. In the present study, we found that the FIB-4 index was a prognostic factor for OS in mCRC patients via univariate Cox regression analysis. Nevertheless, after multivariate analysis, the FIB-4 index did not stand as an independent prognostic factor for OS. The APRI is another index of hepatic fibrosis derived from AST and PLT measurements. 8 In a multicenter study conducted with 1323 patients with CRC and liver metastases, the authors suggested that patients with a higher APRI had significantly better progression-free survival and OS than those with a lower APRI did (p < 0.05). 29 Ashouri et al. reported that among 2374 patients, the APRI was more effective in predicting postoperative liver failure than the Model for End-stage Liver Disease score was. 30 Additionally, the study indicated that an APRI value exceeding 0.365 independently served as a prognostic factor for posthepatectomy liver failure. 30 Even though the current study had a different design and patient selection, the univariate analysis did not show a notable distinction between the APRI and OS (p = 0.131) in stage 4 CRC patients. The primary limitation of the current study its retrospective and single-center design. Another limitation is that subgroup analysis could not be performed as molecular subtypes were not analyzed. In addition, a statistical cutoff value could not be obtained for any parameter because most patients in our study died. CONCLUSIONS The main objective in managing mCRC involves maximizing the patient's quality of life for as much time as possible and increasing survival. In the present study, the ALBI score, GPR, AST/ALT ratio, and age were found to be independent prognostic markers for OS in CRC patients with liver metastases. These simple and affordable parameters may help clinicians predict disease prognosis and tailor treatment accordingly. Declarations Ethics approval and consent to participate: The local ethics committee granted approval for the study protocol (approval date and number: 2024 − 111). Because the study was retrospective, participants were not asked to provide written informed consent when enrolled. Consent for publication: All authors give unconditional approval for the article to be published in the journal. Competing interests: The authors declare no competing interests. Funding: The authors declare no funding interests. Author Contribution M.S.Y, Y.G. ,H.K.AND B.B.B wrote the main manuscript text and C.C AND İ.K. prepared figures 1-2. All authors reviewed the manuscript. Acknowledgements: Nothing to declare. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Conflicts of interest: There are no conflict of interest References Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries . CA Cancer J Clin. 2021;71(3):209-249. Stewart CL, Warner S, Ito K, et al. Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. 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Cite Share Download PDF Status: Published Journal Publication published 20 Feb, 2025 Read the published version in BMC Gastroenterology → Version 1 posted Editorial decision: Revision requested 06 Nov, 2024 Editor assigned by journal 22 Oct, 2024 Submission checks completed at journal 22 Oct, 2024 First submitted to journal 18 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5289132","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":369277268,"identity":"6bc94366-74c5-4582-b39f-005dd6c26032","order_by":0,"name":"Mehmet Serdar YILDIRIM","email":"","orcid":"","institution":"University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Department of Internal Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"Serdar","lastName":"YILDIRIM","suffix":""},{"id":369277269,"identity":"84d13114-073e-4ad7-8825-8b78597f3830","order_by":1,"name":"Yunus 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Medicine","correspondingAuthor":false,"prefix":"","firstName":"İhsan","middleName":"","lastName":"KAPLAN","suffix":""},{"id":369277274,"identity":"2253d492-ce23-4d69-b146-6f6f02366c2b","order_by":4,"name":"Veysi ŞENSES","email":"","orcid":"","institution":"University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Department of Nuclear Medicine","correspondingAuthor":false,"prefix":"","firstName":"Veysi","middleName":"","lastName":"ŞENSES","suffix":""},{"id":369277275,"identity":"223168b2-1a0e-4549-ae81-af482379c005","order_by":5,"name":"İhsan SOLMAZ","email":"","orcid":"","institution":"University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Department of Internal Medicine","correspondingAuthor":false,"prefix":"","firstName":"İhsan","middleName":"","lastName":"SOLMAZ","suffix":""},{"id":369277277,"identity":"0218cd51-71d4-4d30-a9d2-0dc21ff83dca","order_by":6,"name":"Bilgin Bahadır BAŞGÖZ","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIiWNgGAWjYBACAwkeCIMfRCQUkKJFsgGkxYAULQYHwCQRWsylew9+/PHLxt74/OrEDw8MGOT5xQ7g12I551yyNG9fGrPZjbebJYAOM5w5O4GAw27kGEgz9hxmM7txdgNIS4LBbcJajH/+7DnMYzzj7OYfxGoxk+D5cVjCgL93G3G2AP2SZs3bkGYgcYN3m0WCgQRhvwBD7PDNH39s7Pn7z26++aPCRp5fmoAWMGBsAxISYJUSRCgHgz9AzH+AWNWjYBSMglEw0gAAAvJFh9q6cBUAAAAASUVORK5CYII=","orcid":"","institution":"University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Department of Internal Medicine","correspondingAuthor":true,"prefix":"","firstName":"Bilgin","middleName":"Bahadır","lastName":"BAŞGÖZ","suffix":""},{"id":369277279,"identity":"ba277487-e12b-4b83-bf1e-425d45218401","order_by":7,"name":"Ömer Faruk ALAKUŞ","email":"","orcid":"","institution":"University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Department of Internal Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ömer","middleName":"Faruk","lastName":"ALAKUŞ","suffix":""},{"id":369277281,"identity":"a47308e1-76eb-4aed-9d12-498c3c45f03d","order_by":8,"name":"Halil KÖMEK","email":"","orcid":"","institution":"University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Department of Nuclear Medicine","correspondingAuthor":false,"prefix":"","firstName":"Halil","middleName":"","lastName":"KÖMEK","suffix":""}],"badges":[],"createdAt":"2024-10-18 11:38:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5289132/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5289132/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12876-025-03676-7","type":"published","date":"2025-02-20T15:57:11+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":77053735,"identity":"cb705b30-a6d7-4942-9e0c-9b278c66c46f","added_by":"auto","created_at":"2025-02-24 16:30:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":721317,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5289132/v1/a3a5fe8c-5d5b-43fe-bb9b-d519dad2ae9a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Predictive value of the FIB-4 index, APRI, ALBI score, and GPR for overall survival in treatment-naïve metastatic colorectal cancer patients","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eIn recent years, the prevalence of colorectal cancer (CRC) has significantly increased among both men and women and is leading to cancer-related fatalities.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Approximately 20% of individuals diagnosed with CRC have metastatic disease at their time of diagnosis.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e In addition to the liver, regional lymph nodes, the lungs, and the peritoneum could be listed as the most prevalent metastasis sites for CRC.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e The liver, the leading site for distant organ metastasis in CRC patients, determines patient survival time.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Although surgical resection can provide a 5-year survival rate for approximately two-thirds of patients, only 10\u0026ndash;20% of those with CRC with liver metastases are eligible for surgery.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe main goal in treating metastatic CRC (mCRC) is to provide patient with an optimal quality of life for the longest possible time.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Therefore, clinicians should consider factors such as tumor stage and size, underlying liver functions, and the patient performance status. In recent years, increasing interest has been in determining predictive biomarkers for numerous cancers via serologic and hematologic tests \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. A decline in liver function among CRC patients affects the prognosis of the disease.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e The albumin\u0026ndash;bilirubin (ALBI) score indicates the severity of liver dysfunction.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e The aspartate aminotransferase (AST)-to-platelet (PLT) ratio index (APRI), the fibrosis-4 (FIB-4) index and the gamma-glutamyl transpeptidase (GGT)-to-PLT ratio (GPR) are significantly associated with liver fibrosis.\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis retrospective study focused on determining the prognostic significance of scores and markers derived from biochemical tests and hemogram parameters such as the FIB-4 index, ALBI score, APRI, and GPR, on OS in CRC patients with liver metastasis who had not previously received any systemic chemotherapy or local ablative therapy or who had undergone surgery, as detected during the staging process via [18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (\u003csup\u003e18\u003c/sup\u003eFDG-PET/CT) imaging.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis retrospective study enrolled newly diagnosed CRC patients with liver metastases confirmed via \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003eFDG PET/CT; these patients had no distant metastases other than those in the liver or lymph nodes, had not undergone surgery, and had not received any systemic chemotherapy or local ablative therapy, and received at least one course of chemotherapy after imaging between 01/01/2017 and 01/05/2023. Twenty-seven patients whose data were unavailable or who had additional malignancies were excluded.\u003c/p\u003e \u003cp\u003eAge, sex, and biochemical liver tests and hemogram parameters were retrieved for each patient. The ALBI score, FIB-4 index, and APRI were determined via the following formulas: (I) ALBI score = (log\u003csub\u003e10\u003c/sub\u003e bilirubin (\u0026micro;mol/L) \u0026times; 0.66) + (albumin (g/L) \u0026times; \u0026minus;0.0852), (II) FIB-4 index = (age (years) x AST (U/L)) / (PLT (10\u003csup\u003e9\u003c/sup\u003e/L]) x (ALT (U/L)\u003csup\u003e1/2\u003c/sup\u003e), and (III) APRI = [(AST level (IU/L)/ AST (upper limit of normal) (IU/L) /PLT count (109/L)] \u0026times; 100.\u003csup\u003e6,8,10\u003c/sup\u003e Furthermore, the GPR, a fibrosis-related parameter, and the inflammatory parameters AST/PLT, ALT/PLT, and AST/ALT ratios were calculated from biochemical liver tests and hemogram data.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e The dates of death of the patients were noted.\u003c/p\u003e \u003cp\u003e The local ethics committee granted approval for the study protocol (approval date and number: 2024\u0026thinsp;\u0026minus;\u0026thinsp;111). Because the study was retrospective, participants were not asked to provide written informed consent when enrolled. All procedures were conducted according to the Good Clinical Practices Guidelines set by the Turkish Medicine and Medical Devices Agency and the Declaration of Helsinki.\u003c/p\u003e \u003cp\u003eStatistical analysis was performed via SPSS (IBM Corporation, Armonk, New York, United States) version 26.0. The Kaplan\u0026ndash;Meier test (product limit method) and log-rank analysis were used to investigate the impacts of factors on mortality and survival. To measure the effects of prognostic variables on mortality and survival, univariate and multivariate Cox regression analyses were performed via the Enter method. Quantitative variables are expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and median (25th/75th percentile), whereas categorical variables are expressed as n (%). Variables were analyzed at the 95% confidence level, and p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eOne hundred twenty-three patients with mCRC who had not received prior treatment were included. The median age was 59 (17\u0026ndash;92) years, and 56.1% (n\u0026thinsp;=\u0026thinsp;69) of the participants were male. No statistically significant difference was observed in terms of sex between survivors and nonsurvivors (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The overall mortality rate was 85.4% (n\u0026thinsp;=\u0026thinsp;105), and the median OS was 20.1 (min-max: 1-104) months (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the participants' age, baseline scores, and laboratory findings.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAge, baseline scores and laboratory findings of the participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eExitus\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e 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\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-2.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-3.60- -0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.0\u0026ndash;87.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.0-2135.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e23.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e7.0-2135.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.0\u0026ndash;77.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.0-1129.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6.0-1129.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.0-573.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e122.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e43.0-672.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e122.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e43.0-672.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGGT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.0-344.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e53.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.0-1475.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e49.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e10.0-1475.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e288.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e177.0-693.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e282.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e88.0-667.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e282.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e88.0-693.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eINR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.16\u0026ndash;1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.99\u0026ndash;1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.99\u0026ndash;1.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFIB-4 Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.11\u0026ndash;2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.25\u0026ndash;26.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.11\u0026ndash;26.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST to PLT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u0026ndash;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.02\u0026ndash;4.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.01\u0026ndash;4.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT to PLT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u0026ndash;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.01\u0026ndash;2.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.01\u0026ndash;2.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGGT to PLT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02\u0026ndash;1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.02\u0026ndash;4.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.02\u0026ndash;4.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST to PLT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.48\u0026ndash;2.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.51\u0026ndash;4.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.48\u0026ndash;4.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eARPI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.03\u0026ndash;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.06\u0026ndash;12.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.03\u0026ndash;12.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4-97.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1-103.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e20.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1-104\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003eN: Number; Min: Minimum; Max: Maximum; ALBI score: Albumin\u0026ndash;bilirubin score; AST: Aspartate aminotransferase;\u003c/p\u003e \u003cp\u003eALT: Alanine aminotransferase; ALP: Alkaline phosphatase; GGT: Gamma-glutamyl transpeptidase; PLT: Platelet; INR: International normalized Ratio; FIB-4: Fibrosis-4 index; APRI: AST to platelet ratio index; OS: Overall survival\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUnivariate Cox regression analysis revealed that sex, AST/PLT, and ALT/PLT were not significantly associated with OS (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for all). On the other hand, the FIB-4 index (p\u0026thinsp;=\u0026thinsp;0.025), ALBI score (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), GPR (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and AST/ALT ratio (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were associated with poor OS (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe multivariate Cox regression analysis demonstrated that age (95% CI: 1.009\u0026ndash;1.053, p\u0026thinsp;=\u0026thinsp;0.006), ALBI score (95% CI: 1.234\u0026ndash;2.983, p\u0026thinsp;=\u0026thinsp;0.004), AST/ALT (95% CI: 1.193\u0026ndash;2.911, p\u0026thinsp;=\u0026thinsp;0.006), and GPR (95% CI: 1.442\u0026ndash;2.701, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were independent prognostic factors for OS, as summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate Cox regression analyses.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c11\" namest=\"c7\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eB\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eOR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eB\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eOR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eLower\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eUpper\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eLower\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003eUpper\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALBI score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.767\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.977\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.652\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFIB-4 Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.025\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.901\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.607\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST to PLT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.918\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.932\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT to PLT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.639\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGGT to PLT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.572\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.680\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.701\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST to ALT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.574\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.775\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.371\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.864\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.911\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.971\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.607\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.664\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"11\" nameend=\"c11\" namest=\"c1\"\u003e \u003cp\u003eCI: Confidence interval; OR: Odds ratio; ALBI score: Albumin\u0026ndash;bilirubin score; FIB-4: Fibrosis-4 index; PLT: Platelet; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; GGT: Gamma-glutamyl transpeptidase; APRI: AST to platelet ratio index; OS: Overall survival\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe results of this study revealed that age, the ALBI score, the AST/ALT ratio, and the GPR are independent prognostic factors for OS among untreated \u003cem\u003ede novo\u003c/em\u003e mCRC patients.\u003c/p\u003e \u003cp\u003eThe objectives of treating mCRC are to increase patient quality of life for as long as possible and improve survival. Seth et al. reported that patients with CRC and liver metastases who underwent resection had a 5-year survival rate of approximately 35%.\u003csup\u003e3\u003c/sup\u003e The outcome for individuals who underwent liver resection can be predicted before the surgery. The ALBI score is useful for objectively evaluating liver function.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e A decrease in the albumin level indicates liver synthesis dysfunction, leading to a decrease in the ALBI score.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe ALBI score was first employed in patients with a diagnosis of hepatocellular carcinoma (HCC), and it has been noted as a cost-effective, straightforward, and impartial approach to evaluating liver function and as a predictive element in individuals with primary biliary cirrhosis or HCC.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Several subsequent studies have suggested that the ALBI score serves as a prognostic indicator for individuals diagnosed with breast, gastric, or pancreatic cancer.\u003csup\u003e\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e A study by Koh et al. on stage 1\u0026ndash;3 CRC patients revealed that the ALBI score was associated with progression-free survival via both univariate and multivariate analyses.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Additionally, high ALBI scores and age are linked to disease-free survival and OS.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e In a different study, two randomized trials involving patients with stage 4 CRC were combined, and the ALBI score and age were found to be independent prognostic factors.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e In our study, we found that the ALBI score was linked to survival when patients were examined individually. When we conducted a multivariate analysis, we discovered that age and ALBI score independently influenced overall survival, suggesting that our findings aligned with prior research.\u003c/p\u003e \u003cp\u003eRegardless of its etiology, in chronic liver diseases, parenchymal injury progresses through a dynamic process that involves ongoing activation of the inflammatory response, continuous activation of liver fibrogenesis, and a wound healing response marked by the excessive buildup of extracellular matrix components by hepatic myofibroblasts.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e After initial reports on the importance of liver fibrosis in various types of hepatitis, several studies on mCRC patients reported that those with high liver fibrosis scores had a higher prevalence of liver metastases and recurrence than those with low liver fibrosis scores did.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Lemoine and colleagues proposed that the GPR provides more precise results than the APRI and FIB-4 index for detecting liver fibrosis in individuals with chronic hepatitis B.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e The combination of liver function and coagulation status is objectively reflected by the GPR.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e There is increasing evidence that the GPR independently predicts the outcome of different types of cancer.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Ma et al. conducted a meta-analysis involving 1,952 patients and reported that the GPR has favorable accuracy, sensitivity, and prognostic value in patients with HCC.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e Nevertheless, we found no studies on CRC in the literature. Both univariate and multivariate analyses in the current study revealed that the GPR was an independent prognostic factor for predicting OS.\u003c/p\u003e \u003cp\u003eThe degree of hepatocellular damage is associated with increased serum levels of ALT and AST. \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e The ratio of AST to ALT is a biomarker that indicates liver function impairment and can be measured noninvasively. It has been utilized to evaluate the progression of fibrosis in liver diseases including nonalcoholic fatty liver disease (NAFLD).\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e The AST-to-ALT ratio has recently been demonstrated to act as a prognostic indicator for different types of cancer in recent times.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e A study involving CRC patients revealed that higher AST levels and age were correlated with survival.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMoreover, in a study enrolling 536 stage 2\u0026ndash;3 CRC patients, Scheipner et al. reported a potential decline in OS associated with a higher AST/ALT ratio. \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e However, univariate and multivariate analyses did not indicate a statistically significant correlation.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e In the present study, which included stage 4 CRC patients, the ratio of AST to ALT was determined to be a standalone prognostic indicator for OS via both univariate and multivariate analyses (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, and p\u0026thinsp;=\u0026thinsp;0.006, respectively).\u003c/p\u003e \u003cp\u003eThe FIB-4 index, another noninvasive and inexpensive method for evaluating the extent of fibrosis in the liver, has been used in individuals with long-term liver disease, particularly hepatitis C virus.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e NAFLD might be linked to increased liver metastasis. Studies using the FIB-4 index as an indicator of steatosis severity and evaluating the mechanisms associated with metastasis in CRC patients with NAFLD are limited. Patients with CRC may experience a decrease in simultaneous liver metastasis when they have advanced fibrosis in the liver due to NAFLD.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe frequency of NAFLD is rapidly increasing on a global scale; therefore, it is crucial for subsequent clinical studies involving CRC patients to focus on the incidence of NAFLD in different populations. To our knowledge, the effect of the FIB-4 index on prognosis in mCRC patients has not been studied. In the present study, we found that the FIB-4 index was a prognostic factor for OS in mCRC patients via univariate Cox regression analysis. Nevertheless, after multivariate analysis, the FIB-4 index did not stand as an independent prognostic factor for OS. The APRI is another index of hepatic fibrosis derived from AST and PLT measurements.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn a multicenter study conducted with 1323 patients with CRC and liver metastases, the authors suggested that patients with a higher APRI had significantly better progression-free survival and OS than those with a lower APRI did (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003csup\u003e29\u003c/sup\u003e Ashouri et al. reported that among 2374 patients, the APRI was more effective in predicting postoperative liver failure than the Model for End-stage Liver Disease score was.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Additionally, the study indicated that an APRI value exceeding 0.365 independently served as a prognostic factor for posthepatectomy liver failure.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Even though the current study had a different design and patient selection, the univariate analysis did not show a notable distinction between the APRI and OS (p\u0026thinsp;=\u0026thinsp;0.131) in stage 4 CRC patients.\u003c/p\u003e \u003cp\u003eThe primary limitation of the current study its retrospective and single-center design. Another limitation is that subgroup analysis could not be performed as molecular subtypes were not analyzed. In addition, a statistical cutoff value could not be obtained for any parameter because most patients in our study died.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThe main objective in managing mCRC involves maximizing the patient's quality of life for as much time as possible and increasing survival. In the present study, the ALBI score, GPR, AST/ALT ratio, and age were found to be independent prognostic markers for OS in CRC patients with liver metastases. These simple and affordable parameters may help clinicians predict disease prognosis and tailor treatment accordingly.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate:\u003c/h2\u003e\n\u003cp\u003eThe local ethics committee granted approval for the study protocol (approval date and number: 2024\u0026thinsp;\u0026minus;\u0026thinsp;111). Because the study was retrospective, participants were not asked to provide written informed consent when enrolled.\u003c/p\u003e\n\u003ch2\u003eConsent for publication:\u003c/h2\u003e\n\u003cp\u003eAll authors give unconditional approval for the article to be published in the journal.\u003c/p\u003e\n\u003ch2\u003eCompeting interests:\u003c/h2\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding:\u003c/h2\u003e\n\u003cp\u003eThe authors declare no funding interests.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eM.S.Y, Y.G. ,H.K.AND B.B.B wrote the main manuscript text and C.C AND İ.K. prepared figures 1-2. All authors reviewed the manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements:\u003c/h2\u003e\n\u003cp\u003eNothing to declare.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eConflicts of interest:\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThere are no conflict of interest\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries\u003cem\u003e. CA Cancer J Clin.\u003c/em\u003e 2021;71(3):209-249.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eStewart CL, Warner S, Ito K, et al. Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. 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Association of Albumin-Bilirubin Grade and Myosteatosis with its Prognostic Significance for Patients with Colorectal Cancer. \u003cem\u003eAnn Surg Oncol.\u003c/em\u003e 2022;29(6):3868-3876.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAbdel-Rahman O. Prognostic Value of Baseline ALBI Score Among Patients With Colorectal Liver Metastases: A Pooled Analysis of Two Randomized Trials. \u003cem\u003eClin Colorectal Cancer\u003c/em\u003e. 2019;18(1):e61-e68.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eParola M, Pinzani M. Liver fibrosis: Pathophysiology, pathogenetic targets and clinical issues. \u003cem\u003eMol Aspects Med.\u003c/em\u003e 2019;65:37-55.\u003c/li\u003e\n \u003cli\u003eHu X, Marietta A, Dai WX, Li YQ, Ma XJ, Zhang L, Cai SJ, Peng JJ. Prediction of hepatic metastasis and relapse in colorectal cancers based on concordance analyses with liver fibrosis scores. \u003cem\u003eClin Transl Med\u003c/em\u003e. 2020;9(1):13.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLemoine M, Shimakawa Y, Nayagam S, et al. The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa. \u003cem\u003eGut\u003c/em\u003e. 2016;65(8):1369-1376.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Wang Y, Sun K, Shen J, et al. Novel Prognostic Nomograms Based on Inflammation-Related Markers for Patients with Hepatocellular Carcinoma Underwent Hepatectomy. \u003cem\u003eCancer Res Treat.\u003c/em\u003e 2019 Oct;51(4):1464-1478.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSun LJ, Guan A, Xu WY, et al. \u0026gamma;-glutamyl transferase-to-platelet ratio based nomogram predicting overall survival of gallbladder carcinoma. \u003cem\u003eWorld J Gastrointest Oncol.\u003c/em\u003e 2020;12(9):1014-1030.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMa C, Wang N, Ma H, Song K, Yu R, Chen H. Serum gamma-glutamyl transpeptidase-to-platelet ratio (GPR) can predict the prognosis of hepatocellular carcinoma: a meta-analysis and systematic review. \u003cem\u003eTransl Cancer Res\u003c/em\u003e. 2022;11(4):745-753.\u003c/li\u003e\n \u003cli\u003eMcPherson S, Stewart SF, Henderson E, Burt AD, Day CP. Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. \u003cem\u003eGut\u003c/em\u003e. 2010;59(9):1265-1269.\u003c/li\u003e\n \u003cli\u003evon Felden J, Wege H, Schulze K. Elevated Aspartate Aminotransferase to Alanine Aminotransferase Ratio Predicts Poor Outcome in Hepatocellular Carcinoma. \u003cem\u003eHepatol Commun\u003c/em\u003e. 2020;4(9):1382-1383.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLi ZC, Li Z, Li C, et al. Letter: elevated aspartate aminotransferase and aspartate aminotransferase to alanine aminotransferase ratio predicts poor survival in hepatocellular carcinoma after resection. \u003cem\u003eAliment Pharmacol Ther\u003c/em\u003e. 2020;52(11-12):1762-1763.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLindmark G, Gerdin B, P\u0026aring;hlman L, Bergstr\u0026ouml;m R, Glimelius B. Prognostic predictors in colorectal cancer. \u003cem\u003eDis Colon Rectum.\u003c/em\u003e 1994;37(12):1219-1227.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eScheipner L, Smolle MA, Barth D, et al. The AST/ALT Ratio Is an Independent Prognostic Marker for Disease-free Survival in Stage II and III Colorectal Carcinoma. \u003cem\u003eAnticancer Res\u003c/em\u003e. 2021;41(1):429-436.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLv Y, Zhang HJ. Effect of Non-alcoholic Fatty Liver Disease on the Risk of Synchronous Liver Metastasis: Analysis of 451 Consecutive Patients of Newly Diagnosed Colorectal Cancer. \u003cem\u003eFront Oncol.\u003c/em\u003e 2020;10:251.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eChen Q, Deng Y, Li Y, et al. Association of preoperative aspartate aminotransferase to platelet ratio index with outcomes and tumour microenvironment among colorectal cancer with liver metastases. \u003cem\u003eCancer Lett.\u003c/em\u003e 2024;588:216778.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAshouri Y, Hsu CH, Riall TS, Konstantinidis IT, Maegawa FB. Aspartate Aminotransferase-to-Platelet Ratio Index Predicts Liver Failure After Resection of Colorectal Liver Metastases. \u003cem\u003eDig Dis Sci\u003c/em\u003e. 2022;67(10):4950-4958.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Colorectal neoplasms, Survival, Predictive value of tests, Organ dysfunction scores","lastPublishedDoi":"10.21203/rs.3.rs-5289132/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5289132/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of metastatic colorectal cancer (mCRC) is increasing and is linked to poor overall survival (OS). Previous studies have aimed to determine the predictive value of scores and laboratory tests for OS in mCRC patients, but their findings have been inconclusive. In this research, we focused on determining the prognostic significance of the fibrosis-4 (FIB-4) index, the aspartate aminotransferase (AST) to platelet (PLT) ratio index (APRI), the albumin–bilirubin (ALBI) score, and the gamma-glutamyl transpeptidase to PLT ratio (GPR) with respect to OS in treatment-naïve mCRC patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study included treatment-naïve mCRC patients. The FIB-4 index, ALBI score, APRI, and GPR were calculated for each participant, and their mortality dates were recorded. The clinical importance of these scores for survival outcomes was evaluated via the Cox regression model, Kaplan–Meier method, and log-rank test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study enrolled 123 untreated mCRC patients.\u003cstrong\u003e \u003c/strong\u003eUnivariate Cox regression analysis demonstrated that sex and AST/PLT and ALT/PLT counts were not associated with OS (p\u0026gt;0.05 for all). However, a higher FIB-4 index (p=0.025), ALBI score (p\u0026lt;0.001), GPR (p\u0026lt;0.001), and AST/ALT ratio (p\u0026lt;0.001) were all associated with poor OS. Additionally, multivariate Cox regression analysis indicated that age (95% CI: 1.009–1.053, p=0.006), ALBI score (95% CI: 1.234–2.983, p=0.004), GPR (95% CI: 1.442–2.701, p\u0026lt;0.001), and AST/ALT (95% CI: 1.193–2.911, p = 0.006) were independent prognostic factors for OS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe affordable and easily accessible ALBI score, GPR, and AST/ ALT have prognostic value in untreated patients with mCRC.\u003c/p\u003e","manuscriptTitle":"Predictive value of the FIB-4 index, APRI, ALBI score, and GPR for overall survival in treatment-naïve metastatic colorectal cancer patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-04 11:01:59","doi":"10.21203/rs.3.rs-5289132/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-06T13:10:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-23T00:55:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-23T00:55:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2024-10-18T11:32:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"04fb2089-9843-4f54-a276-2df6fd5a5d22","owner":[],"postedDate":"November 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-24T16:23:45+00:00","versionOfRecord":{"articleIdentity":"rs-5289132","link":"https://doi.org/10.1186/s12876-025-03676-7","journal":{"identity":"bmc-gastroenterology","isVorOnly":false,"title":"BMC Gastroenterology"},"publishedOn":"2025-02-20 15:57:11","publishedOnDateReadable":"February 20th, 2025"},"versionCreatedAt":"2024-11-04 11:01:59","video":"","vorDoi":"10.1186/s12876-025-03676-7","vorDoiUrl":"https://doi.org/10.1186/s12876-025-03676-7","workflowStages":[]},"version":"v1","identity":"rs-5289132","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5289132","identity":"rs-5289132","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}