Abstract: Objective To investigate the correlation and combined predictive efficacy of peripheral blood alkaline phosphatase/prealbumin (ALP/PA),systemic immune inflammatory index (SII),and alpha-fetoprotein variant ratio (AFP-L3%) with prognosis after radical resection of liver cancer.Methods A retrospective study was conducted on 157 patients who underwent radical resection for liver cancer and were admitted to our hospital from January 2020 to March 2023.Patients were divided into progression group and non-progression group according to whether their condition progressed 18 months after surgery.Prognosis status was conducted,and the clinical data of the two groups were compared with respect to preoperative peripheral blood ALP/PA,SII,and AFP-L3%.Logistic regression analysis was used to analyze the factors affecting the postoperative disease progression.Receiver operating characteristic (ROC) curve was used to analyze the predictive value of different schemes for postoperative disease progression.Results The recurrence and metastasis rate was 38.85% (61/157) in the 157 patients at 18 months after surgery.AFP,the percentage of patients with Chinese liver cancer stage (CNLC) III,the percentage of patients with vascular cancer embolism,and preoperative peripheral blood ALP/PA,SII,and AFP-L3% were higher in the progression group than in the non-progression group,and the differences were statistically significant (P<0.05).Logistic regression analysis showed that elevated AFP (OR=1.131),stage III CNLC (OR=3.501),vascular tumor thrombus (OR=3.418),elevated ALP/PA (OR=1.409),elevated SII (OR=1.230),and elevated AFP-L3% (OR=1.380) were all independent risk factors for postoperative disease progression (P<0.05).ROC analysis showed that the area under the curve (AUC) of the new indicators ALP/PA,SII,and AFP-L3% combined to predict postoperative disease progression was 0.907,which was the largest and superior to the predictive efficacy of each indicator alone and traditional indicators alone and combined.Conclusion The peripheral blood ALP/PA,SII,and AFP-L3% are closely related to the progression of liver cancer after radical resection,and combined detection has certain predictive value for postoperative disease progression.

Key words: alkaline phosphatase/prealbumin, systemic immune inflammatory index, the ratio of AFP isoforms to AFP, liver cancer, radical resection, prognosis, predictive efficiency