Prognostic significance of globulin/low-density lipoprotein ratio in patients with hepatocellular carcinoma after local ablative therapy: a retrospective cohort study

Background: Low-density lipoprotein (LDL) and globulin (GLOB) have been found to be predictors for some malignant tumors, but their predictive value in hepatocellular carcinoma (HCC) has hardly been elucidated. This study assessed the prognostic significance of GLOB to LDL ratio (GLR) in HCC patients before ablation.

Methods: This study analyzed 312 early-stage HCC patients who were hospitalized and underwent ablative treatment in Beijing You'an Hospital, Capital Medical University, from 1 January 2014 to 1 January 2019. The primary endpoint was the recurrence-free survival (RFS), calculated from treatment initiation to cancer recurrence, whereas the overall survival (OS) was measured from treatment initiation to death or last follow-up. Cox regression analysis was used to assess the GLR independently associated with recurrence and survival. OS and RFS were calculated by Kaplan-Meier analysis and compared between groups using the log rank test. The optimal cut-off value and prognostic role of GLR and other markers were evaluated via the receiver operating characteristic (ROC) curves and the Youden index.

Results: Univariate and multivariate analysis found that the tumor number, tumor size, and GLR were independent risk factors of relapse, whereas etiology, tumor number, tumor size, fibrinogen (Fib), and GLR were related to OS. We classified the patients into groups with high and low levels of GLR based on the optimal cut-off value of GLR identified by ROC curve. The cumulative 1-, 3-, and 5-year RFS rates in the low GLR group were 76.4%, 53.8%, and 43.4% respectively, whereas those in the high GLR group were 71%, 31%, and 22%, respectively (P<0.001). In terms of OS, the low GLR group showed a 1-, 3-, and 5-year OS of 99.5%, 92.0%, and 80.2% respectively, and 98%, 73%, and 63% respectively for the high GLR group (P<0.001). Finally, patients were stratified by GLR and tumor size. The outcomes revealed that patients in group A (GLR <16.54 and tumor size ≤30 mm) showed better prognosis than those in group B (GLR ≥16.54 and tumor size ≤30 mm or GLR <16.54 and tumor size >30 mm) and group C (GLR ≥16.54 and tumor size >30 mm) (P<0.001).

Conclusions: Preoperative GLR ratio has predictive value for patients with HCC who have undergone complete ablation.