Preoperative Albumin-Globulin Ratio and Its Association with Perioperative and Long-Term Outcomes in Patients Undergoing Pancreatoduodenectomy

Abstract

<b><i>Background:</i></b> Systemic inflammatory response is involved in natural progression of cancers by different pathways. Albumin-globulin ratio (AGR) has been reported to have impact on prognosis in various solid tumors. <b><i>Objective:</i></b> To study the significance of AGR on perioperative and long-term outcomes in patients undergoing PD. <b><i>Methods:</i></b> This is a post hoc analysis of the pancreatic surgery database from January 2012 to March 2017. Cutoff value for AGR was calculated by using the receiver operating curve, and the study cohort was divided into group I (AGR ≥1) and group II (AGR <1). Two groups were compared for perioperative and long-term survival outcomes. <b><i>Results:</i></b> Two groups were comparable with respect to clinicodemographic variables. Groups I and II had similar perioperative outcomes (<i>p</i> > 0.05) like median hospital stay (14 vs. 15 days), clinically relevant postoperative pancreatic fistula (16.6 vs. 15.7%), hemorrhage (3.1 vs. 2.6%), bile leak (1.4 vs. 0.65%), overall morbidity (30.1 vs. 28.9%), and postoperative mortality (2.7 vs. 3.9%). With a median follow-up of 3 years, median survival, overall survival, and disease-free survival were similar in both groups. <b><i>Conclusion:</i></b> AGR at the cutoff value of ≥1 was not associated with adverse perioperative and long-term oncological outcomes after PD.

The Role of Albumin-Globulin Ratio on Predicting Postoperative Pancreatic Fistula in Pancreaticoduodenectomy Patients

“…In multiple logistic regression analysis, a low albumin-globulin ratio was found to be an independent risk factor in the diagnosis of POPF. Unlike our study, Shinde et al found no association between AGR and CR-POPF development [23]. In their study, patients with a serum albumin < 3gr/dl were not subjected to surgery and cutoff value for AGR was set at 1 (area under curve,0.53).…”

“…Many studies have shown that AGR, like albumin levels, has a prognostic factor in several cancers including gastric, colorectal, breast, ovarian, and nasopharyngeal cancers [20][21][22]. On the other hand, in the only study of the literature investigating the significance of AGR on perioperative and long-term outcomes of patients who underwent PD, Shinde et al [23]. found no adverse effects on perioperative and oncological outcomes at the cut off value of 1.…”

Clinical impact of pretreatment albumin–globulin ratio in patients with colorectal cancer

“…[34] AGR has been confirmed as a prognostic factor in many solid organ malignant tumors. [35][36][37] A previous meta-analysis revealed that high preoperative AGR was correlated with poor OS, DFS, and PFS across various types of cancer. [34] Moreover, the prognostic value of preoperative AGR remained constant regardless of AGR cut-off values and cancer type, although AGR cut-off values were heterogeneous, ranging from 0.9 to 1.93 for some cancers.…”