Prognostic significance of the albumin-to-globulin ratio for upper tract urothelial carcinoma

Abstract

Background: Although the albumin-to-globulin ratio (AGR) is a promising biomarker for various malignancies, few studies have investigated its prognostic significance for upper tract urothelial carcinoma (UTUC). Methods: This retrospective study conformed to the REporting recommendations for tumour MARKer prognostic studies (REMARK) guideline. We reviewed 179 patients with UTUC who underwent radical nephroureterectomy at our institution between 2008 and 2018. Associations of preoperative clinicopathological factors, including the AGR, with cancer-specific survival (CSS) and overall survival (OS) were assessed. The Cox proportional hazards model was used for univariate and multivariable analyses. AGR was dichotomized as < 1.25 and ≥ 1.25, according to the most discriminatory cutoff determined from the receiver operating characteristic curve analysis. Results: During a median follow-up of 34 months after surgery, 37 patients died from UTUC and 13 died of other causes. The preoperative AGR significantly correlated with pathological T stage, pathological N stage, and adjuvant chemotherapy. Multivariate analyses demonstrated that a decreased (< 1.25) preoperative AGR was an independent poor prognostic factor for both CSS (hazard ratio [HR] = 2.81, P < 0.01) and OS (HR = 2.09, P < 0.05). Conclusions: Preoperative AGR < 1.25 might serve as a useful prognostic marker for patients with UTUC undergoing radical nephroureterectomy.

Prognostic Significance of the Albumin-to-globulin Ratio for Advanced Urothelial Carcinoma Treated with Pembrolizumab: A Multicenter Retrospective Study

“…[18], and upper tract UC treated with radical nephroureterectomy [19][20][21][22][23][24]. Most of these studies [16][17][18][19][20][21][22][23] demonstrate the utility of the AGR as a readily available predictive biomarker for patients with UC. To our knowledge, the present study is the rst to demonstrate the potential utility of the AGR in the setting of advanced UC, and thus adds further evidence in this eld.…”

“…The link between a low AGR and poor outcomes of patients with cancer is not fully established but may be explained in general terms as follows [23,29]: First, previous studies show that poor nutritional status or hypoalbuminemia is a predictor of poor prognosis for patients with cancer [29]. Second, chronic in ammation involving serum globulins is required for tumor proliferation, immune evasion, and metastasis.…”

“…Although the concept of AGR was introduced long ago, it was not applied to oncology until the 2010s [14,15]. Several studies assessed the prognostic signi cance of the AGR of patients with UC [16][17][18][19][20][21][22][23][24] in settings of bladder cancer treated with radical cystectomy [16,17], non-muscle-invasive bladder cancer…”

“…Among biomarkers of patients with UC, the neutrophil-to-lymphocyte ratio (NLR) [7] is a well-established marker in patients with advanced UC [8][9][10][11][12][13], including those treated with pembrolizumab [9][10][11][12][13]. Similarly, the albumin-to-globulin ratio (AGR) is an established marker in oncology [14][15][16][17][18][19][20][21][22][23][24]. Although several studies assessed AGR in patients with UC [16][17][18][19][20][21][22][23][24], none evaluated its prognostic signi cance in the setting of "advanced UC."…”

“…Similarly, the albumin-to-globulin ratio (AGR) is an established marker in oncology [14][15][16][17][18][19][20][21][22][23][24]. Although several studies assessed AGR in patients with UC [16][17][18][19][20][21][22][23][24], none evaluated its prognostic signi cance in the setting of "advanced UC." Therefore, the present study assessed the prognostic signi cance of the AGR together with the NLR and other pretreatment clinicopathological variables of patients with advanced UC who were treated with pembrolizumab.…”