Combination of Albumin-Globulin Score and Sarcopenia to Predict Prognosis in Patients With Renal Cell Carcinoma Undergoing Laparoscopic Nephrectomy

Abstract

We conducted a multicenter clinical study to construct a novel index based on a combination of albumin-globulin score and sarcopenia (CAS) that can comprehensively reflect patients' nutritional and inflammatory status and assess the prognostic value of CAS in renal cell carcinoma (RCC) patients. Between 2014 and 2019, 443 patients from 3 centers who underwent nephrectomy were collected (343 in the training set and 100 in the test set). Kaplan-Meier curves were employed to analyze the impact of albumin-globulin ratio (AGR), albumin-globulin score (AGS), sarcopenia, and CAS on overall survival (OS) and cancer-specific survival (CSS) in RCC patients. Receiver operating characteristic (ROC) curves were used to assess the predictive ability of AGR, AGS, sarcopenia, and CAS on prognosis. High AGR, low AGS, and nonsarcopenia were associated with higher OS and CSS. According to CAS, the training set included 60 (17.5%) patients in grade 1, 176 (51.3%) patients in grade 2, and 107 (31.2%) patients in grade 3. Lower CAS was linked to longer OS and CSS. Multivariate Cox regression analysis revealed that CAS was an independent risk factor for OS (grade 1 vs. grade 3: aHR = 0.08; 95% CI: 0.01–0.58, p = 0.012; grade 2 vs. grade 3: aHR = 0.47; 95% CI: 0.25–0.88, p = 0.018) and CSS (grade 1 vs. grade 3: aHR = 0.12; 95% CI: 0.02–0.94, p = 0.043; grade 2 vs. grade 3: aHR = 0.31; 95% CI: 0.13–0.71, p = 0.006) in RCC patients undergoing nephrectomy. Additionally, CAS had higher accuracy in predicting OS (AUC = 0.687) and CSS (AUC = 0.710) than AGR, AGS, and sarcopenia. In addition, similar results were obtained in the test set. The novel index CAS developed in this study, which reflects patients' nutritional and inflammatory status, can better predict the prognosis of RCC patients.

Prognostic Significance of Pre- to Postoperative Dynamics of Sarcopenia for Patients with Renal Cell Carcinoma Undergoing Laparoscopic Nephrectomy

“…A meta-analysis showed that patients with sarcopenia had worse OS (HR = 1.76; 95% CI, 1.35–2.31; P < 0.001). In addition, our previous studies confirmed that sarcopenia was an independent prognostic risk factor for patients with RCC ( 16 , 17 , 28 ).…”

“…A growing number of studies have shown that sarcopenia is associated with poor prognosis in oncology patients and is even an independent risk factor for prognosis ( 14 , 15 ). Our previous study found sarcopenia assessed by preoperative SMI measurements to be an independent risk factor for RCC patients ( 16 , 17 ). However, muscle mass, nutrition and inflammatory status may differ preoperatively and postoperatively due to primary tumor eradication, and major surgery can affect the physical condition of patients ( 18 ).…”

Clinical significance of albumin to globulin ratio among patients with stroke-associated pneumonia

“…According to previous publications, A/G was independently associated with various cancers, such as lung cancer, squamous cell carcinoma of the maxillary sinus, diffuse large B cell lymphoma, and metastatic gastric cancer. These studies concluded that cancer patients with a low A/G had a worse overall and disease-free survival rate than those with a higher A/G ( 9 , 14 – 17 ). The present study indicated that patients with a lower A/G (A/G ≤ 1.09) had a higher SAP risk, while those with a higher A/G (A/G ≥ 1.4) had a lower risk.…”

Prognostic and Clinicopathological Correlations of Pretreatment Prognostic Nutritional Index in Renal Cell Carcinoma: A Meta-Analysis

“…Fifth, the HRs extracted from the survival curve and univariate analysis may be not accurate as a matter of fact. Sixth, other than PNI, there are also other scores that are just as easy to use for prognosis prediction of RCC patients (e.g., Glasgow Prognostic Score [52][53][54], systemic immune-inflammation index [55], albumin-globulin score [56], platelet index score [57], et al). It may be necessary to determine which prognostic factor may be more accuracy [39] or whether different score systems should be integrated [56,58].…”

“…Sixth, other than PNI, there are also other scores that are just as easy to use for prognosis prediction of RCC patients (e.g., Glasgow Prognostic Score [52][53][54], systemic immune-inflammation index [55], albumin-globulin score [56], platelet index score [57], et al). It may be necessary to determine which prognostic factor may be more accuracy [39] or whether different score systems should be integrated [56,58]. In summary, the prognostic and clinical values of pretreatment PNI in RCC still need to be confirmed by prospective large-scale studies which involve patients from various geographic areas and perform the comparison with other factors in the future.…”