Clinical significance of the globulin-to-albumin ratio for prediction of postoperative survival in patients with colorectal cancer

Aim: A previous study has revealed that the albumin/globulin ratio (GAR) before treatment is a predictor of cancer-specific survival in patients with colorectal cancer (CRC). The aim of the present study was to investigate the clinical significance of GAR for prediction of postoperative survival in patients with CRC.

Methods: Nine hundred and forty-one patients who had undergone elective CRC surgery were enrolled. Uni- and multivariate analysis models were performed to detect the clinical characteristics that were most closely associated with overall survival (OS). All recommended cutoff values were defined using receiver operating characteristic curve (ROC) analyses. Kaplan-Meier analysis was used to compare the OS curves between the high GAR (GAR > 0.83) and low GAR (GAR ≤ 0.83) groups.

Results: Multivariate analysis using eight clinical characteristics selected by univariate analyses showed that the GAR was associated with OS (>0.83/≤0.83) (hazard ratio [HR], 1.979; 95% CI, 1.321-2.966; P = 0.001) along with carcinoembryonic antigen (CEA; >8.7/≤8.7, ng/mL; HR, 2.319; 95% CI, 1.569-3.428; P < 0.001), carbohydrate antigen 19-9 (CA19-9; >18.5/≤18.5, U/mL; HR, 1.727; 95% CI, 1.178-2.532; P = 0.005), and the neutrophil-to-lymphocyte ratio (NLR; >2.9/≤2.9; HR, 2.132; 95% CI, 1.454-3.126; P < 0.001), and the area under the ROC (AUROC) curve revealed that the GAR had the largest AUROC among these four clinical characteristics (GAR 0.711 > CEA 0.698 > CA19-9 0.676 > NLR 0.635). A significant difference in OS was observed between patients with low GAR and those with high GAR (P < 0.001).

Conclusion: Globulin-to-albumin ratio is a useful predictor of postoperative survival in patients with CRC.