Albumin-to-Alkaline Phosphatase Ratio: A Novel Prognostic Index of Overall Survival in Cisplatin-based Chemotherapy-treated Patients with Metastatic Nasopharyngeal Carcinoma

Abstract

The Albumin-to-Alkaline Phosphatase Ratio (AAPR) has been recently revealed as a prognostic index for hepatocellular carcinoma, whereas its role in metastatic nasopharyngeal cancer (NPC) remains unclear. The aim of this study was to evaluate the clinical value of AAPR in patients with metastatic NPC. We retrospectively reviewed 209 metastatic NPC patients treated with cisplatin-based regimens. Survival data were calculated using the Kaplan-Meier method and were compared using the log-rank test. Univariate and multivariate survival analyses were conducted using the Cox proportional hazards regression methodology. The optimal cutoff level of AAPR for assessing overall survival (OS) was 0.447, which was determined by R software. An AAPR less than 0.447 was significantly associated with a higher lactate dehydrogenase (LDH) level (273 vs. 185 U/L, P = 0.004), a higher EBV DNA viral load (5.59×105 vs. 3.49×104 copies/ml, P = 0.001), and more liver and bone metastases (P = 0.005 and P = 0.001, respectively). Additionally, patients with an AAPR < 0.447 had a shorter overall survival and progression-free survival (hazard ratio: 3.269, 95% confidence interval: 1.710-6.248; HR: 2.295, 95% confidence interval: 1.217-4.331, respectively) than those with an AAPR ≥ 0.447. Our study suggested that the AAPR might be a novel prognostic factor in metastatic NPC patients treated with cisplatin-based regimens. However, a prospective study to validate its prognostic value is needed, and the mechanisms underlying the low AAPR and poor survival in metastatic NPC need to be further investigated.

The prognostic value of the preoperative albumin to alkaline phosphatase ratio in patients with non‐small cell lung cancer after surgery

“…first reported the prognostic value of the AAPR and revealed that the AAPR was a significant prognostic predictor in hepatocellular carcinoma (HCC) . Similar studies have been subsequently reported in other types of cancers, including small cell lung cancer (SCLC) . However, the prognostic value of the AAPR has not yet been well studied in non‐small cell lung cancer (NSCLC) patients.…”

“…the AAPR was found to be an independent prognostic factor for OS and DFS in patients with HCC regardless of the treatment approach . Since then, the AAPR has been proven to be a significant prognostic predictor for nasopharyngeal carcinoma, SCLC, and upper tract urothelial carcinoma (UTUC), whereas it has not yet been explored in patients with NSCLC …”

Prognostic role of pre‐treatment serum albumin in patients with nasopharyngeal carcinoma: A meta‐analysis and systematic review

“…Full texts of these 16 remaining studies were assessed according to the inclusion and exclusion criteria, and 6 articles failed to offer sufficient prognostic information. Finally, as shown in Figure , a total of 10 studies comprising 7339 cases were included in this meta‐analysis . Patients were from different cancer centres and were assessed at different time points and differed in metastatic or non‐metastatic NPC.…”

“…Finally, as shown in Figure 1, a total of 10 studies comprising 7339 cases were included in this meta-analysis. 20,21,[25][26][27][28][29][30][31][32] Patients were from different cancer centres and were assessed at different time points and differed in metastatic or non-metastatic NPC.…”

<p>The Prognostic Significance Of Pretreatment Albumin/alkaline Phosphatase Ratio In Patients With Stage IB-IIA Cervical Cancer</p>

“…11 Subsequently, it has been reported as a novel prognostic factor in different malignant carcinomas, including nasopharyngeal carcinoma, pancreatic ductal adenocarcinoma, breast cancer, lung cancer, and cholangiocarcinoma. [12][13][14][15][16][17] However, the pretreatment level of AAPR and their prognostic role in cervical cancer have not ever been evaluated. Hence, we retrospectively studied the prognostic significance of AAPR in cervical cancer patients with stage IB-IIA disease, followed by the correlation of AAPR with other clinicopathological features.…”