Preoperative Albumin-to-Globulin Ratio Predicts Prognosis in Hepatocellular Carcinoma: A Cohort Study Including Non-Hepatitis Virus-Infected Patients

<b><i>Introduction:</i></b> We evaluated the prognostic significance of the preoperative albumin-to-globulin ratio (AGR) in patients with hepatocellular carcinoma (HCC) with various liver etiologies. <b><i>Methods:</i></b> We retrospectively analyzed 157 patients with HCC between July 2010 and February 2021. The relationship between clinicopathological variables was investigated using univariate and multivariate analyses. Statistical significance was set at <i>p</i> &#x3c; 0.05. <b><i>Results:</i></b> The mean overall survival (OS) was 24.5 months. The 1-, 3-, and 5-year OS rates were 90.4%, 81.2%, and 68.7%, respectively. Patients were classified into 2 groups: AGR &#x3c;1.16 (low-AGR group; <i>n</i> = 43) and AGR ≥1.16 (high-AGR group; <i>n</i> = 114). In univariate analysis, OS was significantly reduced in patients with a low AGR (AGR &#x3c;1.16), an alpha-fetoprotein level ≥25 ng/mL, a tumor size ≥3.5 cm, microvascular invasion, and poor tumor differentiation. In multivariate analysis, a low AGR (hazard ratio [95% confidence interval]) (2.394 [1.092–5.213]; <i>p</i> = 0.030) and microvascular invasion (2.268 [1.019–5.169]; <i>p</i> = 0.045) were independent predictors of OS. <b><i>Discussion/Conclusion:</i></b> A low AGR was significantly associated with poor OS in patients with HCC, regardless of liver etiology. This may assist in treatment stratification and better management of patients with HCC.