This study aimed to comprehensively assess the diagnostic value of fibrinogen to prealbumin ratio (FPR) and gamma-glutamyl transpeptidase to platelet ratio (GPR) as single markers or in combination in patients with alpha-fetoprotein-negative (AFP-negative) hepatocellular carcinoma (HCC). A total of 199 healthy controls and 515 AFP-negative patients were enrolled in this study, including 180 HCC inpatients, 151 liver cirrhosis (LC) patients, and 184 chronic hepatitis (CH) cases. Mann–Whitney U or Kruskal–Wallis H test were used to analyze differences between groups in laboratory parameters and clinicopathological features. The diagnostic value of FPR and GPR, alone or in combination, in AFP-negative HCC (AFP-NHCC) patients was determined via a receiver operating characteristic (ROC) curve. The levels of FPR and GPR were gradually increased in the development of AFP-NHCC and positively correlated with the tumor size and Barcelona Clinic Liver Cancer (BCLC) stages. Moreover, GPR was associated with Edmondson–Steiner grades. After univariate logistic regression analysis, FPR and GPR remained independent predictors of adverse outcomes. The combination of FPR and GPR had a good ability to detect AFP-NHCC from the control group (area under curve [AUC] = 0.977), AFP-negative CH (AUC = 0.745), and AFP-negative LC (AUC = 0.666). FPR combined with GPR possessed a larger area (0.943, 0.971) and sensitivity (87.50%, 89.81%) than FPR or GPR alone for differentiating AFP-NHCC with tumor size < 3 cm or at the BCLC-A stage. The pretreatment levels of FPR and GPR played vital roles in the development of AFP-NHCC, especially in patients with early or small AFP-NHCC.

中文翻译：

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纤维蛋白原与前白蛋白比值和γ-谷氨酰转肽酶与血小板比值在AFP阴性肝细胞癌进展中的诊断价值

本研究旨在全面评估纤维蛋白原与前白蛋白比值（FPR）和γ-谷氨酰转肽酶与血小板比值（GPR）作为单一标志物或联合使用对甲胎蛋白阴性（AFP阴性）肝细胞癌患者的诊断价值。肝癌）。本研究共纳入199名健康对照和515名AFP阴性患者，其中HCC住院患者180名，肝硬化（LC）患者151名，慢性肝炎（CH）患者184名。Mann-Whitney U 或 Kruskal-Wallis H 检验用于分析组间实验室参数和临床病理学特征的差异。FPR 和 GPR 单独或联合在 AFP 阴性 HCC (AFP-NHCC) 患者中的诊断价值通过受试者工作特征 (ROC) 曲线确定。FPR和GPR水平在AFP-NHCC的发展过程中逐渐升高，并且与肿瘤大小和巴塞罗那临床肝癌（BCLC）分期呈正相关。此外，GPR 与 Edmondson-Steiner 等级相关。经过单变量逻辑回归分析，FPR 和 GPR 仍然是不良结果的独立预测因子。FPR 和 GPR 的组合对对照组的 AFP-NHCC（曲线下面积 [AUC] = 0.977）、AFP 阴性 CH（AUC = 0.745）和 AFP 阴性 LC（AUC = 0.666）具有良好的检测能力. FPR联合GPR比单独使用FPR或GPR具有更大的面积（0.943, 0.971）和敏感性（87.50%, 89.81%），用于鉴别肿瘤尺寸<3 cm或BCLC-A分期的AFP-NHCC。FPR和GPR的预处理水平在AFP-NHCC的发展中起着至关重要的作用，