Novel prognostic scores based on serum ferritin/globulin ratio in patients with hepatocellular carcinoma

BACKGROUND: The level of ferritin has been shown to be associated with the prognosis of various tumors. In this study, we proposed prognostic indicator, named ferritin/globulin ratio (FGR), and to evaluate the important value in hepatocellular carcinoma (HCC). METHODS: A total of 472 HCC patients and 219 healthy controls were concluded in our retrospective study. The clinical characteristics were analyzed in these patients. The optimal cutoff value of the prognostic factors (α-fetoprotein, alanine aminotransferase, aspartate aminotransferase, ferritin, globulin and FGR) were determined by using receiver operating characteristic curve analysis, and then analyzed by univariate and multivariate Cox hazard models to evaluate the prognostic significance. RESULTS: Serum ferritin, globulin and FGR levels were significantly higher in HCC patients than in healthy controls. Multivariate analysis showed that FGR was a significant and independent risk factor OS (HR =1.575; 95% CI: 1.122–2.212; P=0.009) and DFS (HR =1.569; 95% CI: 1.117–2.204; P=0.009) in whole patients. Furthermore, we also classified the data according to α-fetoprotein (AFP), alanine aminotransferase (ALT) and aspartate aminotransferase (AST), highly significant differences of FGR were observed between the two groups in OS and DFS. High FGR levels were associated with poor OS and DFS in HCC patients. CONCLUSIONS: The serum FGR levels may serve as a significant predictor of prognosis in HCC patients.