Association between preoperative aspartate aminotransferase-to-platelet ratio index and prognosis in colorectal liver metastases: a systematic review and meta-analysis

Background: This study intended to examine the predictive ability of the preoperative aspartate aminotransferase-to-platelet ratio index (APRI) for the prognosis of individuals with colorectal liver metastases (CRLM) undergoing surgical resection. We aimed to evaluate the associations of APRI with overall survival (OS), progression-free survival (PFS), and postoperative complications to offer a reference for preoperative risk stratification.

Methods: The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD420251058027). PubMed, EMBASE, Web of Science (WOS), and Cochrane were retrieved from inception to April 23, 2025. Quantitative synthesis was restricted to homogeneous surgical cohorts to minimize clinical heterogeneity. Meta-analysis was carried out leveraging STATA 15.1 and Meta-Disc 1.4.

Results: In total, 10 studies were incorporated for systematic review. The meta-analysis of surgical cohorts revealed that a higher preoperative APRI tended to be associated with reduced OS [hazard ratio (HR) =1.14, 95% confidence interval (CI): 1.01–1.28, P<0.05]. For recurrence-related outcomes, one multicenter study found a significant association between high APRI and shorter PFS (HR =1.24, 95% CI: 1.04–1.48, P=0.02), whereas other studies reported directionally similar but non-significant findings. Furthermore, an elevated APRI was associated with an increased risk of clinical postoperative complications [odds ratio (OR) =1.76, 95% CI: 1.00–3.07, P=0.05] and with underlying pathological liver injuries, including sinusoidal obstruction syndrome (SOS) and nodular regenerative hyperplasia (NRH). Exploratory analysis suggested APRI may have potential predictive value for postoperative outcomes, although results were influenced by heterogeneity across studies.

Conclusions: An elevated preoperative APRI may be linked to poorer survival and an increased likelihood of postoperative complications in individuals with CRLM. Given its simple calculation and low cost, APRI may serve as a practical supplementary tool for preoperative risk stratification. However, due to the limited number of studies for certain endpoints and observed heterogeneity, these findings should be interpreted cautiously, and further large-scale prospective trials are warranted.