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International Journal of Clinical and Experimental Medicine Research

ISSN Online: 2575-7970 ISSN Print: 2575-7989 CODEN: IJCEMH
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ArticleOpen Access http://dx.doi.org/10.26855/ijcemr.2026.03.014

Research Progress of Albumin-to-Alkaline Phosphatase Ratio (AAPR) in Digestive System Tumors

Xiaoyan Xue, Gefu Chi*

Hospital of Inner Mongolia Medical University, Hohhot 010050, Inner Mongolia, China.

*Corresponding author: Gefu Chi

Published: March 31,2026

Abstract

Albumin-to-alkaline phosphatase ratio (AAPR), a composite biomarker based on routine biochemical indicators, integrates serum albumin (reflecting nutritional status and hepatic synthetic function) and alkaline phosphatase (indicating hepatobiliary damage and tumor invasion). First proposed by Chan et al. in 2015 for hepatocellular carcinoma prognosis, AAPR has demonstrated significant clinical value across digestive system malignancies. In hepatocellular carcinoma, AAPR>0.40 predicts superior overall and recurrence-free survival. For cholangio-carcinoma, AAPR≥0.41 correlates with improved 5-year survival rates (33.4% vs. 16.5%). In pancreatic cancer, AAPR≤0.4 identifies patients with markedly short-ened survival (6.4 vs. 9.3 months). Gastric and colorectal cancer studies confirm low AAPR as an independent predictor of poor prognosis (HR=2.49, 95% CI: 1.67-3.71). Additionally, AAPR<0.50 significantly predicts worse outcomes in esophageal squamous cell carcinoma. Despite the advantages of convenience, low cost, and stability, AAPR faces limitations, including non-unified cutoff values and comorbidity interference. Future research should establish standardized thresholds, validate them through multi-center prospective studies, and expand applications in rare digestive tumors.

Keywords

Albumin-to-alkaline phosphatase ratio (AAPR); digestive system tumors; prognostic biomarker; hepatocellular carcinoma; cholangiocarcinoma; pancreatic cancer; gastric cancer

References

[1] Nazha B, Moussaly E, Zaarour M, et al. Hypoalbuminemia in colorectal cancer prognosis: Nutritional marker or inflammatory surrogate? World J Gastrointest Surg. 2015;7:370-7.

[2] Tunç S, Cetinkaya A, Duman O. Spectroscopic investigations of the interactions of tramadol hydrochloride and 5-azacytidine drugs with human serum albumin and human hemoglobin proteins. Photochem Photobiol B. 2013;120:59-65.

[3] Eckart A, Struja T, Kutz A, et al. Relationship of Nutritional Status, Inflammation, and Serum Albumin Levels During Acute Illness: A Prospective Study. Am J Med. 2020;133(6):713-22.

[4] Seaton K. Albumin concentration controls cancer. J Natl Med Assoc. 2001;93:490-3.

[5] Rozga J, Piątek T, Małkowski P. Human albumin: old, new, and emerging applications. Ann Transplant. 2013;18:205-17.

[6] Zaher DM, El-Gamal MI, Omar HA, et al. Recent advances with alkaline phosphatase isoenzymes and their inhibitors. Arch Pharm (Weinheim). 2020;353:e2000017.

[7] Orimo H. The mechanism of mineralization and the role of alkaline phosphatase in health and disease. Nippon Med Sch. 2010;77(1):4-12.

[8] Wu XL. Changes and clinical significance of serum alkaline phosphatase in hyperthyroidism patients before and after treatment [dissertation]. Shanxi Medical University; 2023.

[9] Lowe D, Sanvictores T, Zubair M, et al. Alkaline Phosphatase. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Oct 29.

[10] Magnusson P, Degerblad M, Sääf M, et al. Different responses of bone alkaline phosphatase isoforms during recombinant insulin-like growth factor-I (IGF-I) and during growth hormone therapy in adults with growth hormone deficiency. J Bone Miner Res. 1997;12(2):210-20.

[11] Magnusson P, Sharp CA, Farley JR. Different distributions of human bone alkaline phosphatase isoforms in serum and bone tissue extracts. Clin Chim Acta. 2002;325(1-2):59-70.

[12] Jiang Y, Li X, Walt DR. Single-Molecule Analysis Determines Isozymes of Human Alkaline Phosphatase in Serum. Angew Chem Int Ed Engl. 2020;59:18010-5.

[13] Yang J, Chen Y, Wan J, et al. Prognostic value of the C-reactive protein to albumin ratio in patients with stroke: a meta-analysis. Sci Rep. 2025;15(1):21150.

[14] Taş-Aygar G, Ataş H, Gönül M, et al. Importance of the C-Reactive Protein to Albumin Ratio in the Diagnosis and Prognosis of Mycosis Fungoides. Dermatol Pract Concept. 2024;14(2):e2024097.

[15] Kocatürk M, Kocatürk Ö. Assessment of relationship between C-reactive protein to albumin ratio and 90-day mortality in patients with acute ischaemic stroke. Neurol Neurochir Pol. 2019;53(3):205-11.

[16] Seringec Akkececi N, Yildirim Cetin G, Gogebakan H, et al. The C-Reactive Protein/Albumin Ratio and Complete Blood Count Parameters as Indicators of Disease Activity in Patients with Takayasu Arteritis. Med Sci Monit. 2019;25:1401-9.

[17] Fu YJ, Li KZ, Bai JH, et al. C-reactive protein/albumin ratio is a prognostic indicator in Asians with pancreatic cancers: A meta-analysis. Medicine (Baltimore). 2019;98(48):e18219.

[18] Kalyoncuoglu M, Durmus G. Relationship between C-reactive protein-to-albumin ratio and the extent of coronary artery disease in patients with non-ST-elevated myocardial infarction. Coron Artery Dis. 2020;31(2):130-6.

[19] Chan AW, Kumada T, Toyoda H, et al. Albumin-to-Alkaline Phosphatase Ratio: A Novel Prognostic Index for Hepatocellular Carcinoma. Dis Markers. 2015;2015:564057.

[20] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality world-wide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.

[21] Zhang X, Xin Y, Chen Y, et al. Prognostic effect of albumin-to-alkaline phosphatase ratio on patients with hepatocellular carcinoma: a systematic review and meta-analysis. Sci Rep. 2023;13(1):1808.

[22] Li H, Wang L, Chen L, et al. Prognostic Value of Albumin-to-Alkaline Phosphatase Ratio in Hepatocellular Carcinoma Patients Treated with Liver Transplantation. Cancer (Basel). 2020;11(8):2171-80.

[23] Yousif WI, Bakosh MF. Prognostic Impact of Initial Laboratory-based Scores for Hepatocellular Carcinoma Patients: A Retro-spective Study. Clin Exp Hepatol. 2025;15(6):102604.

[24] Li Q, Lyu Z, Wang L, et al. Albumin-to-Alkaline Phosphatase Ratio Associates with Good Prognosis of Hepatitis B Virus-Positive HCC Patients. Onco Targets Ther. 2020;13:2377-84.

[25] Zhang F, Lu SX, Hu KS, et al. Albumin-to-alkaline phosphatase ratio as a predictor of tumor recurrence and prognosis in patients with early-stage hepatocellular carcinoma undergoing radiofrequency ablation as initial therapy. Int J Hyperthermia. 2021;38(1):1-10.

[26] Cai X, Chen Z, Chen J, et al. Albumin-to-Alkaline Phosphatase Ratio as an Independent Prognostic Factor for Overall Survival of Advanced Hepatocellular Carcinoma Patients without Receiving Standard Anti-Cancer Therapies. Cancer (Basel). 2018;9(1):189-97.

[27] Bertuccio P, Turati F, Carioli G, et al. Global trends and predictions in hepatocellular carcinoma mortality. J Hepatol. 2017;67(2):302-9.

[28] Greten TF, Schwabe R, Bardeesy N, et al. Immunology and immunotherapy of cholangiocarcinoma. Nat Rev Gastroenterol Hepatol. 2023;20(6):349-65.

[29] Ilyas SI, Gores GJ. Pathogenesis, diagnosis, and management of cholangiocarcinoma. Gastroenterology. 2013;145(6):1215-29.

[30] Li H, Li J, Wang J, et al. Assessment of Liver Function for Evaluation of Long-Term Outcomes of Intrahepatic Cholangiocarci-noma: A Multi-Institutional Analysis of 620 Patients. Front Oncol. 2020;10:525.

[31] Xiong JP, Long JY, Xu WY, et al. Albumin-to-alkaline phosphatase ratio: A novel prognostic index of overall survival in cholan-giocarcinoma patients after surgery. World J Gastrointest Oncol. 2019;11(1):39-47.

[32] Zhang F, Lu S, Tian M, et al. Albumin-to-Alkaline Phosphatase Ratio is an Independent Prognostic Indicator in Combined Hepa-tocellular and Cholangiocarcinoma. Cancer (Basel). 2020;11(17):5177-86.

[33] Wenzel P, von Figura G. Diagnostik und Therapie des Pankreaskarzinoms [Diagnostics and therapy of pancreatic carcinoma]. Dtsch Med Wochenschr. 2021;146(4):246-52.

[34] Zhang K, Dong S, Jing YH, et al. Albumin-to-alkaline phosphatase ratio serves as a prognostic indicator in unresectable pancreatic ductal adenocarcinoma: a propensity score matching analysis. BMC Cancer. 2020;20(1):541.

[35] Haksoyler V, Topkan E. Prognostic Utility of Prechemoradiotherapy Albumin-to-Alkaline Phosphatase Ratio in Unresectable Locally Advanced Pancreatic Carcinoma Patients. Gastroenterol Res Pract. 2021;2021:6647145.

[36] Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87-108.

[37] Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-63.

[38] Siegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A. Cancer statistics, 2025. CA Cancer J Clin. 2025;75(1):10-45.

[39] Ness RM, Llor X, Abbass MA, et al. NCCN Guidelines® Insights: Colorectal Cancer Screening, Version 1.2024. J Natl Compr Canc Netw. 2024;22(7):438-46.

How to cite this paper

Research Progress of Albumin-to-Alkaline Phosphatase Ratio (AAPR) in Digestive System Tumors

How to cite this paper: Xiaoyan Xue, Gefu Chi. (2026) Research Progress of Albumin-to-Alkaline Phosphatase Ratio (AAPR) in Digestive System Tumors. International Journal of Clinical and Experimental Medicine Research10(2), 134-138.

DOI: http://dx.doi.org/10.26855/ijcemr.2026.03.014