Preoperative albumin-to-globulin ratio as a significant prognostic indicator in urologic cancers: a meta-analysis

Abstract

BackgroundEmerging studies reported that preoperative albumin-to-globulin ratio (AGR) correlated with tumor progression and prognosis in several types of cancer. The aim of this study was to systematically explore the association between preoperative AGR and clinical outcomes in cancers of the urinary system.MethodsRelevant articles were searched in PubMed, Embase and Web of Science by two independent investigators from inception to June 1, 2018. Eligible studies were selected based on predetermined selection criteria. Summarized HRs or ORs and 95% CIs were calculated for prognosis and clinicopathologic features with the fixed-effects or random-effects models.ResultsEight cohort studies comprising 2,668 patients were included for analysis. The pooled results showed that a low AGR significantly correlated with poor OS (HR: 0.38, 95% CI: 0.27–0.48, P<0.001), worse cancer-specific survival (CSS) (HR: 0.36, 95% CI: 0.22–0.50, P<0.001) and inferior event-free survival (EFS) (HR: 0.36, 95% CI: 0.25–0.48, P<0.001) in urologic cancers. In addition, patients in low and high AGR groups showed significant differences in lymphovascular invasion (P<0.001), pT status (P<0.001) and pN status (P<0.001).ConclusionPreoperative AGR might be a valuable, cheap and reproducible prognostic bio-marker in urologic cancers following surgical resection.

<p>Clinical significance of systemic immune-inflammation index (SII) and C-reactive protein-to-albumin ratio (CAR) in patients with esophageal cancer: a meta-analysis</p>

“…Increasing evidence has shown systemic inflammatory responses and nutritional status were involved in tumor development and considered as important factors associated with clinical prognosis in various types of cancers 5–8. And therefore a series of biological indicators based on inflammatory and/or nutritional status have been reported as tumor biomarkers 9–11. Among them, systemic immune-inflammation index (SII), defined as neutrophil × platelet/lymphocyte, was initially known as an indicator of the host inflammatory status as well as a prognostic marker in hepatocellular carcinoma 12.…”

Prognostic value of albumin-to-globulin ratio in COVID-19 patients: A systematic review and meta-analysis

“…Low albumin levels are associated with malnutrition and inflammation, whereas low globulin levels are associated with chronic inflammation and indicate cumulative exposure to various pro-inflammatory cytokines [ 55 ]. AGR is considered a more stable and reliable marker than serum albumin or globulin alone as a prognostic factor and has been associated with poor results in relation to different pathologies, such as digestive and urological cancers and solid cancers in general 56 , 57 , 58 . Similarly, it was associated with the prognosis of other diseases, such as heart failure and chronic kidney disease 10 , 59 .…”

Significance of albumin to globulin ratio as a predictor of febrile urinary tract infection after ureteroscopic lithotripsy

“…Albumin can be influenced by various confounding factors such as stress, illness, hepatic insufficiency, and changes in the volume of body fluids, and this could affect the efficiency and accuracy of albumin as a prognostic marker [20]. Previous studies have proposed that AGR provides an assessment of albumin and globulin together, which could reflect the body's nutritional status and inflammatory states comprehensively, and this increases its value as a novel biochemical index [20,21]. Thus, patients with a lower AGR could be more susceptible to acute inflammatory conditions (especially fUTI) after surgery.…”