Albumin-to-alkaline phosphatase ratio serves as a prognostic indicator in unresectable pancreatic ductal adenocarcinoma: a propensity score matching analysis

Abstract

Background: Recent evidence suggests that albumin-to-Alkaline Phosphatase Ratio (AAPR) functions as a novel prognostic marker in several malignancies. However, whether it can predict the prognosis of unresectable pancreatic ductal adenocarcinoma (PDAC) remains unclear. Herein, we seek to investigate this possibility by a propensity score matching (PSM) analysis. Methods: This was a retrospective cohort study in which 419 patients diagnosed with unresectable PDAC and receiving chemotherapy were recruited. Patients were stratified based on the cutoff value of AAPR. The PSM analysis was performed to identify 156 well-balanced patients in each group for overall survival (OS) comparison and subgroup analysis. Univariate and multivariate analyses were carried out to examine the potential of AAPR to indicate the prognosis of unresectable PDAC. The prediction performance of conventional model and combined model including AAPR was compared using the Akaike Information Criterion (AIC) and concordance index (C-index). Results: We identified an AAPR of 0.4 to be the optimal cutoff for OS prediction. Patients with AAPR≤0.4 had significantly shorter OS compared with patients with AAPR> 0.4 (6.4 versus 9.3 months; P < 0.001). Based on the PSM cohort and entire cohort, multivariate Cox analysis revealed that high pretreatment for AAPR was an independent marker predicting favorable survival in unresectable PDAC (hazard ratio, 0.556; 95% confidence interval, 0.408 to 0.757; P < 0.001). Significant differences in OS were observed in all subgroups except for the group of patients age ≤ 60. Combined prognostic model including AAPR had lower AIC and higher C-index than conventional prognostic model. Conclusions: Pretreatment AAPR servers as an independent prognostic indicator for patients with unresectable PDAC. Inclusion of AAPR improved the prediction performance of conventional prognostic model, potentially helping clinicians to identify patients at high risk and guide individualized treatment.

Preoperative Alkaline Phosphatase-to-Cholesterol Ratio as a Predictor of Overall Survival in Pancreatic Ductal Adenocarcinoma Patients Undergoing Radical Pancreaticoduodenectomy

“…Moreover, higher ALP levels have been demonstrated to serve as a risk factor for lymph node metastasis in esophageal cancer [ 24 ], correlate with a later stage in colon cancer [ 25 ], and promote cell invasion and metastasis in pancreatic carcinoma; whereas, decreased ALP activity can reportedly inhibit tumor cell metastasis and invasion [ 26 ]. Other studies have indicated that the ratios of ALP to serum albumin and ALP to lactate dehydrogenase might predict the OS of patients with resectable and unresectable pancreatic carcinoma, respectively [ 11 , 12 ].…”

“…Relevant reports have found that alkaline phosphatase (ALP) plays a major role in inflammation by affecting purine signal transduction, which can stop inflammatory signals and thus induce immunosuppression [ 10 ]. Furthermore, the predictive value of ALP combined with other biomarkers has been reported in resectable and nonresectable pancreatic carcinoma [ 11 – 13 ]. Additionally, in patients undergoing immunotherapy, higher cholesterol (CHO) levels are known to be associated with a better prognosis [ 14 ].…”

Non-linear Association of Alkaline Phosphatase-to-Albumin Ratio with All-Cause and Cancer Mortality: Evidence from NHANES 2005-2016

“…The ALP-to-ALB ratio (APAR), a novel prognostic marker amalgamating ALP and ALB, has been proposed and exhibits promising prognostic value in various cancers and other diseases [6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Moreover, APAR exhibits superior predictive performance for clinical outcomes when compared with independent ALP and ALB measurements [20].…”

Predictive potential of albumin-alkaline phosphatase ratio for cerebrovascular accident in patients with antineutrophil cytoplasmic antibody–associated vasculitis

“…And according to the clinical characteristics, AAV is categorized into three subtypes; microscopic polyangiitis, granulomatosis with polyangiitis, and eosinophilic granulomatosis with polyangiitis. 1,2 Central nervous system involvement of AAV is not a frequently observed systemic manifestation, and cerebrovascular accident (CVA) may occur in a minority of AAV patients. 3 As such, the low frequency of CVA involvement makes it difficult to predict and detect among AAV patients.…”