![]() Curative hepatectomy was defined as complete resection of all microscopic and macroscopic HCC tumors with microscopically clear resection margins in the surgical specimens (R0 resection). Patients with HCC who underwent partial hepatectomy with curative intent from January 2009 to December 2016 at four Chinese medical centers (Southwest Hospital, Zhejiang Provincial People’s Hospital, Eastern Hepatobiliary Surgery Hospital, and Chongqing University Cancer Hospital) were identified, and their clinical data were retrospectively analyzed. ![]() 27, 29īased on a multicenter database with more than 10 years of follow-up, the present study aimed to identify whether preoperative albumin-to-globulin ratio independently predicted long-term overall survival and recurrence-free survival outcomes in patients with HCC after partial hepatectomy with curative-intent. 27 – 29 Furthermore, two of these studies only performed prognostic analyses on overall survival but not on recurrence-free survival. 24 – 26 The correlation between preoperative albumin-to-globulin ratio with long-term prognosis in patients treated with hepatectomy for HCC has only been reported in 3 single-center studies with small sample sizes. 10, 11 Moreover, the albumin-to-globulin ratio has also been demonstrated to correlate with prognosis of patients with various diseases, especially with malignant tumors such as colorectal cancer, 12 – 14 urothelial carcinoma, 15 – 19 gastric cancer, 20 – 23 and lung cancer. An inversed albumin-to-globulin ratio (IAGR, <1.0) is often found in patients with severe inflammatory liver diseases or cirrhosis. Underproduction of albumin or overproduction of globulin leads to decrease of the albumin-to-globulin ratio. 9 The normal threshold value of the albumin-to-globulin ratio is 1.0 to 2.0. 8 A surrogate index by combining albumin with globulin to form the albumin-to-globulin ratio is often used clinically to access liver function. A high level of globulin (normal range 20~35 g/L) indicates immune system overactivity, which is often found in patients with chronic inflammatory diseases such as chronic hepatitis. 7, 8 A low serum level of albumin (normal range 35–50 g/L) reflects either poor nutritional status of the patient or poor synthetic function of the liver. Liver function tests used in clinical practice routinely include serum albumin, globulin, bilirubin and transaminases levels. 5, 6 A better understanding of perioperative risk factors associated with tumor recurrence and long-term survival helps in surgical decision-making, although whether adjuvant therapy can improve long-term oncological prognosis following hepatectomy for HCC is still debatable. 4, 5 Most studies reported 5-year HCC recurrence rates of 60% to 70% after curative resection. 2, 3 However, a high post-hepatectomy tumor recurrence rate limits the long-term prognosis. 1 Hepatectomy is the first-line treatment aiming at cure in selected patients. Hepatocellular carcinoma (HCC) has high morbidity and poor survival rates all over the world.
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