Inversed albumin-to-globulin ratio and underlying liver disease severity as a prognostic factor for survival in hepatocellular carcinoma patients undergoing transarterial chemoembolization

PURPOSE: Previous studies have shown that an inversed albumin-to-globulin ratio (IAGR) is a predictor of the prognosis of many cancers. However, the prognostic value of an IAGR for patients with hepatocellular carcinoma (HCC) who undergo transarterial chemoembolization (TACE) is still unclear. This study aims to evaluate the predictive value of an IAGR for the prognosis of those patients. METHODS: This study retrospectively analyzed 396 patients with HCC who received TACE. Using a cut-off value of 1.0 for the albumin-to-globulin ratio, patients were divided into a normal albumin-to-globulin ratio (NAGR) (≥1) and an IAGR (<1) group. Univariate and multivariate analyses and time-dependent receiver operating characteristic analyses were performed to identify risk factors of overall survival (OS) and cancer-specific survival (CSS). Survival nomograms were constructed based on the multivariable analysis results and further evaluated using the consistency index (C-index) and calibration curve. RESULTS: A total of 396 patients were included in the final analysis and were divided into the NAGR group (n = 298, 75.3%) and the IAGR (n = 98, 24.7%) group. The median OS and CSS were significantly worse in the IAGR group than in the NAGR group (OS: 8 vs. 26 months, CSS: 10 vs. 41 months, both P < 0.001). Multivariate analyses demonstrated that an IAGR was an independent risk factor for predicting worse OS [hazard ratio (HR), 2.024; 95% confidence interval (CI): 1.460–2.806] and CSS (HR: 2.439; 95% CI: 1.651–3.601). The nomogram-based model-related C-indexes for OS and CSS prediction were 0.715 (95% CI: 0.697–0.733) and 0.750 (95% CI: 0.729–0.771), and the calibration of the nomogram showed good consistency. CONCLUSION: The IAGR along with underlying liver disease severity were the useful prognostic predictors of OS and CSS among patients with HCC undergoing TACE and might be useful to identify high-risk patients.