Abstract
AIMS: This study aimed to investigate the clinical value of the glucose-albumin ratio (GAR) in predicting the prognosis of cancer patients prescribed anthracycline-based chemotherapy. METHODS: We included cancer patients who underwent anthracycline-based chemotherapy, drawn from the population-based cohort Clinical Data Analysis Reporting System of Hong Kong between January 2000 and December 2019. Demographics, medical history, baseline laboratory, and metabolic indicators, including GAR, were collected. We employed random survival forests (RSF) with the variable importance (VIMP) method to rank the importance of these variables. Cox proportional hazards regression was used to assess the association between GAR levels and event risks. RESULTS: A total of 18,700 patients were included in the analysis. The top 2 factors for predicting overall cardiovascular event risk were GAR and fasting blood glucose (FBG). Our results revealed that a higher GAR was significantly associated with poorer cardiovascular prognosis in patients with cancer prescribed with anthracycline-based chemotherapy. Compared to the lowest quartile, higher GAR levels were significantly associated with increased risk of all-cause mortality, major adverse cardiovascular events, hospitalization of heart failure, and cardiovascular mortality regardless of the adjustments (all p trend < 0.001). CONCLUSION: GAR is a potential biomarker for predicting the prognosis of cancer patients undergoing anthracycline-based chemotherapy. Monitoring GAR levels before and during treatment may help identify patients at higher risk of adverse outcomes, facilitating personalized treatment strategies and improving clinical management.