Fang AP, et al. - In this prospective cohort study, researchers examined the link between serum levels of copper, zinc and their ratio (copper/zinc) at diagnosis with hepatocellular carcinoma (HCC) survival in 989 patients with incident HCC who were enrolled in the Guangdong Liver Cancer Cohort (GLCC) study between September 2013 and February 2017 within 30 days of diagnosis. Inductively coupled plasma mass spectrometry was used to determine serum copper and zinc. The multivariable hazard ratios (HRs) and 95% confidence interval (CI) were estimated using Cox proportional hazards models. Findings revealed strong associations of higher serum copper levels with worse liver cancer-specific survival (LCSS) and overall survival (OS). There was a positive association of calculated copper/zinc ratio with LCSS and OS. In the entire cohort, they found no overall associations were observed between serum zinc levels and LCSS or OS. Overall, worse HCC survival could be observed in association with higher serum copper and copper in relation to zinc levels (ie, higher copper/zinc ratio), but serum zinc levels may be not related to HCC survival.