The Prognostic Value of Preoperative Albumin-to-Alkaline Phosphatase Ratio on Survival Outcome for Patients With Locally Advanced Oral Squamous Cell Carcinoma

Abstract

Background: This retrospective cohort study was to assess the prognostic value of preoperative albumin-to-alkaline phosphatase ratio (AAPR) on survival outcome for patients with locally advanced oral squamous cell carcinoma (LAOSCC). Methods: A total of 250 patients with LAOSCC receiving upfront radical surgery at a single institute from January 2008 to December 2017 were enrolled. The primary endpoint was the survival predictability of preoperative AAPR on the 5-year overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Cox proportional hazards model was used for survival analysis. The X-tile software was used to estimate the optimal cut-off value of preoperative AAPR on survival prediction. A predictive nomogram incorporating the clinicopathological factors on OS was further generated. Results: The 5-year OS, CSS, and DFS rates were 68.6%, 79.7%, and 61.7%, respectively. The optimal cut-off of preoperative AAPR to predict the 5-year OS was observed to be 0.51. For those with preoperative AAPR≧0.51, the 5-year OS, CSS, and DFS were statistically significantly superior to those with preoperative AAPR<0.51 (OS: 76.1% vs 48.5%, P < .001; CSS: 84.3% vs 66.4%, P = .005; DFS: 68.9% vs 42.6%, P < .001). In Cox model, we observed that preoperative AAPR<0.51 was a significantly negative prognosticator of OS (HR: 2.22, 95% CI: 1.466-3.361, P < .001), CSS (HR: 2.037, 95% CI: 1.16-3.578, P = .013), and DFS (HR: 1.756, 95% CI: 1.075-2.868, P = .025). After adding the variable of preoperative AAPR, the c-index of the predictive nomogram incorporating assorted clinicopathological factors increases from 0.663 to 0.692 for OS. Conclusion: Our results suggest that preoperative AAPR serves as an independent survival predictor for patients with LAOSCC. The nomogram incorporating preoperative AAPR and various clinicopathological features may be a convenient tool to estimate the mortality risk for patients with LAOSCC.

Preoperative Albumin-to-Alkaline Phosphatase Ratio as an Independent Predictor of Lymph Node Involvement in Penile Cancer

“…Alkaline phosphatase seems to be a regulator of immune response, involved in tumor growth regulation, metastasis, and progression. Recent evidence suggested that ALP can serve as a tumor-associated antigen and biomarker of cancer cell proliferation [ 21 ].…”

Elevated pretreatment lactate dehydrogenase and albumin-to-alkaline phosphatase ratio predict poor prognosis and early treatment discontinuation in head and neck cancer patients with preexistent diabetes mellitus

“…In comparison to AAPR<0.51, the pre-operative values of AAPR ≧0.51 were associated with a significantly higher OS (76.1% vs 48.5%), CSS (84.3% vs 66.4%), and DFS (68.9% vs 42.6%). A nomogram that includes both clinical-pathological characteristics and preoperative AAPR could accurately predict 5-year outcomes of locally advanced oral squamous cell carcinoma cases (46,47). The prognostic value of the AAPR was assessed for a cohort of 342 cases of HNC treated with concurrent chemoradiotherapy.…”

Prognostic utility of neutrophil‐to‐albumin ratio in surgically treated oral squamous cell carcinoma

“…13 Serum albumin concentration is commonly employed as a means of assessing malnutrition, which have been found to be prognostically significant in patients with head and neck cancer. [14][15][16][17][18] Our previous studies had also reported that increasing postoperative complication with poor prognosis were associated with lower serum albumin concentration in patients with head and neck cancer. 19 To integrate the above biomarkers, Bernard et al introduced a new metric, the neutrophil-to-albumin ratio (NAR), which is calculated by dividing the absolute neutrophil count (ANC) by the serum albumin concentration.…”

“…Meanwhile, malnutrition has also been frequently discussed in evaluating the condition and prognosis of cancer patients 13 . Serum albumin concentration is commonly employed as a means of assessing malnutrition, which have been found to be prognostically significant in patients with head and neck cancer 14–18 . Our previous studies had also reported that increasing postoperative complication with poor prognosis were associated with lower serum albumin concentration in patients with head and neck cancer 19 …”