<p>Prognostic Value of Pretreatment Albumin-to-Alkaline Phosphatase Ratio in Extensive-Disease Small-Cell Lung Cancer: A Retrospective Cohort Study</p>

Abstract

Purpose: Evidence regarding the relationship between albumin-to-alkaline phosphatase ratio (AAPR) and overall survival (OS) in extensive-disease small-cell lung cancer (ED-SCLC) patients is limited. This study aimed to investigate whether AAPR was independently related to OS in ED-SCLC patients after adjusting for potential covariates. Patients and Methods: This was a retrospective cohort study of 224 patients with ED-SCLC. The target independent and dependent variables were pretreatment AAPR and OS, respectively. Covariates included age; sex; Eastern Cooperative Oncology performance status score; smoking history; existence of metastasis to organs such as the bone, lung, liver, brain, malignant plural effusion and others; sum of organ metastasis (≤3, >3), evaluation of firstline treatment; and sum of treatment lines (<2, ≥2). Student's t test or chi-squared test was used to analyze the associations between AAPR and clinical characteristics. Kaplan-Meier survival analysis and Cox's proportional hazards regression model were used to assess the prognostic value of AAPR for OS. Results: The average patient age was 60.51±8.73 years, and 87.95% were men. A non-linear relationship between AAPR and OS was detected, with an inflection point of 0.35. The hazard ratios (HRs) of the left (AAPR <0.35) and right sides (AAPR ≥0.35) of inflection point were 0.04 (95% CI=0.00-0.70, p=0.0268) and 0.52 (95% CI=0.16-1.64, p=0.2659), respectively. Kaplan-Meier analysis showed a median OS of 9.73 months (95% CI=8.6-12.33) for AAPR <0.35 and 13.7 months (95% CI=11.43-16.37) for AAPR ≥0.35 (log-rank p<0.0001). The Cox proportional hazards model showed that AAPR <0.35 increased the risk of death after adjusting for potential confounders (HR=1.65, 95% CI=1.11-2.46). In subgroup analysis, the trends of HRs were increased across all subgroups with AAPR <0.35 after stratification. Conclusion: Pretreatment AAPR might be served as an independent prognostic indicator in ED-SCLC patients. Our findings should be further validated in large-scale and prospective clinical trials.

Pretreatment Albumin-to-Alkaline Phosphatase Ratio Is a Prognostic Marker in Lung Cancer Patients: A Registry-Based Study of 7077 Lung Cancer Patients

“…In SCLC, previous studies have shown more divergent results [ 15 , 18 , 21 ]. In line with us, Zhou et al [ 21 ] found a decreased OS in patients with a pretreatment AAPR < 0.35 as compared with patients with a pretreatment AAPR > 0.35 (adjusted HR = 1.65 (95% CI 1.11–2.46)) in 224 SCLC patients with extended disease.…”

“…In SCLC, previous studies have shown more divergent results [ 15 , 18 , 21 ]. In line with us, Zhou et al [ 21 ] found a decreased OS in patients with a pretreatment AAPR < 0.35 as compared with patients with a pretreatment AAPR > 0.35 (adjusted HR = 1.65 (95% CI 1.11–2.46)) in 224 SCLC patients with extended disease. However, a correlation between pretreatment levels of the AAPR and OS could not be confirmed in a study evaluating 300 SCLC patients with extended disease [ 15 ] or in a study of 122 SCLC patients with limited disease [ 18 ].…”

“…However, the AAPR has been evaluated only in lung cancer patients in a limited number of studies [ 13 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ], and therefore the evidence in lung cancer is scarce. In addition, the AAPR has solely been examined in lung cancer patients of Chinese origin and in studies including restricted sample sizes.…”

Albumin-to-alkaline phosphatase ratio as a promising indicator of prognosis in human cancers: is it possible?

“…However, results from these emerging findings are inconsistent. For instance, some of them evinced that elevated AAPR was associated with poor survival outcomes [ 9 , 10 , 12 – 21 , 23 – 26 ], but others evinced that elevated AAPR was not correlated with survival outcomes [ 11 , 22 ]. Additionally, qualities of the above mentioned studies are variable, especially in terms of cancer types and methodology.…”

Prognostic Value of Pretreatment Albumin-to-Alkaline Phosphatase Ratio in Cancer: A Meta-Analysis

“…One article was excluded because it did not have a single cutoff value, and another was excluded because it did not report prognosis. Finally, 16 articles involving 5,716 cases were included in our meta-analysis [ 10 , 12 – 15 , 18 – 27 ]. The flow chart of document retrieval is illustrated in Figure 1 .…”