Tan Maoqing, You Ruolan, Cai Danni, Wang Jin, Dai Wei, Yang Rong, Li Dongliang, Huang Huifang
Central Laboratory, Fujian Medical University Union Hospital, Fuzhou, Fujian, 350001, China.
Follow-Up Center, Fujian Medical University Union Hospital, Fuzhou, Fujian, 350001, China.
Int J Med Sci. 2025 Jan 1;22(2):441-450. doi: 10.7150/ijms.103125. eCollection 2025.
The prognostic significance of the red blood cell distribution width to albumin ratio (RAR) spans various diseases, yet its utility as a biomarker for hepatitis B virus-related hepatocellular carcinoma (HBV-HCC) remains unclear. We retrospectively studied 1,413 patients with HBV-HCC. Receiver operating characteristic curves identified optimal RAR cut-offs, stratifying patients into H-RAR and L-RAR groups. Propensity score matching helped balance baseline characteristics. We further evaluated the incremental predictive value of RAR by incorporating it into established conventional models. Overall, 906 patients with HBV-HCC were enrolled (H-RAR group, 600 (66.2%); L-RAR group, 306 (33.8%)). After propensity score matching, 209 patients were included in each group with balanced baseline characteristics (all > 0.05). RAR demonstrated superior prognostic discrimination compared to red blood cell distribution width, albumin, total bilirubin, and Child-Pugh scores alone, with an area under the curve (AUC) of 0.751. The risk of all-cause mortality increased progressively within a specific RAR range. High RAR was identified as an independent risk factor for long-term overall survival in patients with HBV-HCC (hazard ratio = 1.707, 95% confidence interval [CI]: 1.338-2.176). Stratification by tumour stage revealed substantially lower overall survival for H-RAR than for L-RAR across Tumour, Node, Metastasis I-IV stages. Incorporating RAR into traditional HCC staging systems substantially improved the ability to predict overall mortality risk. RAR is a novel and valuable prognostic indicator for patients with HBV-HCC.
红细胞分布宽度与白蛋白比值（RAR）在多种疾病中都具有预后意义，但其作为乙型肝炎病毒相关肝细胞癌（HBV-HCC）生物标志物的效用仍不明确。我们对1413例HBV-HCC患者进行了回顾性研究。通过绘制受试者工作特征曲线确定了RAR的最佳截断值，将患者分为高RAR组（H-RAR）和低RAR组（L-RAR）。倾向得分匹配有助于平衡基线特征。我们通过将RAR纳入已建立的传统模型，进一步评估了其增量预测价值。总体而言，共纳入906例HBV-HCC患者（H-RAR组600例（66.2%）；L-RAR组306例（33.8%））。倾向得分匹配后，每组纳入209例患者，基线特征均衡（均>0.05）。与单独的红细胞分布宽度、白蛋白、总胆红素和Child-Pugh评分相比，RAR显示出更好的预后判别能力，曲线下面积（AUC）为0.751。在特定的RAR范围内，全因死亡风险逐渐增加。高RAR被确定为HBV-HCC患者长期总生存的独立危险因素（风险比=1.707，95%置信区间[CI]：1.338-2.176）。按肿瘤分期分层显示，在肿瘤、淋巴结、转移I-IV期，H-RAR组的总生存率显著低于L-RAR组。将RAR纳入传统的HCC分期系统可显著提高预测总死亡风险的能力。RAR是HBV-HCC患者一种新的有价值的预后指标。
