The pretreatment albumin to globulin ratio, a validated biomarker, predicts prognosis in hepatocellular carcinoma

Purpose: Although the albumin to globulin ratio (AGR) has been proven to be a prognostic factor in several cancers, no studies have assessed its prognostic significance in hepatocellular carcinoma (HCC). Therefore, this study aimed to investigate the prognostic value of the pretreatment AGR in the survival in HCC patients. Methods: 150 patients were enrolled, who were confirmed of HCC from October 2008 to December 2012 in Nanfang Hospital of Southern Medical University. Demographic, clinical and laboratory data were obtained. Univariate and multivariate Cox regression analysis were used to investigate the association of clinicopathological parameters with HCC patients' survival. Results: Patients were divided into 2 groups: AGR<1.18 and AGR Patients in the high AGR (>= 1.18) group had longer overall survival (OS) than those in the low AGR (<1.18) group (60.16 vs 20.48 months, p<0.001). Univariate analysis showed that portal vein tumor thrombosis, grade of differentiation, extrahepatic metastasis, BCLC stage, AFP level and AGR at diagnosis were significantly associated with OS. Multivariate analysis revealed that AGR (p<0.001) and grade of differentiation (p=0.007) were independent prognostic factors for survival of HCC patients. In subgroup analysis based on age and Child-Pugh class, AGR remained a significant prognostic parameter. Conclusion: Low pretreatment AGR was significantly associated with shorter OS in HCC patients. The pretreatment AGR could be a useful and effective prognostic index for identifying patients with poor prognosis, even when patients have well-preserved liver reserve function.