The prognostic value of the pretreatment serum albumin to globulin ratio for predicting adverse pathology in patients undergoing radical prostatectomy for prostate cancer

Abstract

Purpose Few studies have demonstrated the clinical significance of pretreatment serum albumin and globulin in prostate cancer (PCa). This study evaluated the association between the pretreatment albumin to globulin ratio (AGR) and clinicopathologic characteristics of nonmetastatic PCa in a large multicenter setting in Korea. Materials and Methods This study involved 742 patients with nonmetastatic PCa who underwent radical prostatectomy (RP) in seven institutions between January 2011 and December 2012. The AGR was calculated as follows: albumin/(total protein−albumin). Patients were divided into low and high AGR groups by a cutoff value from a receiver operating characteristic curve analysis. Results The best cutoff for the AGR was set at 1.53. The area under the curve of the AGR was 0.624 (95% confidence interval, 0.557–0.671; p<0.001). Patients who had a lower pretreatment AGR (<1.53) were identified as the low AGR group (n=398, 53.6%) and the remaining patients as the high AGR group (n=344, 46.4%). Preoperative AGR was significantly lower in patients with non-organ-confined disease (≥pT3) than in those with organ-confined disease (≤pT2) (p<0.001). The low AGR group had higher aggressive pathologic Gleason scores (pGS) (≥8) than did the high AGR group (p=0.016). Furthermore, the AGR was an independent prognostic factor for high pGS (≥8) and non-organ-confined disease (≥pT3), according to multivariate logistic regression analysis. Conclusions A low AGR was closely associated with nonconfined disease (≥pT3) and high pGS (≥8). AGR can be a useful serological marker for predicting adverse pathology in patients with nonmetastatic PCa who undergo RP.

Prognostic value of pretreatment serum albumin−globulin ratio in urothelial carcinoma: A systematic review and meta-analysis

“…Recently, studies have shown that AGR can be used as an economic and practical marker to evaluate the therapeutic effect and prognosis of different cancers ( 15 – 17 , 38 ). Similarly, for UC patients, most studies identified that AGR before treatment was an independent prognostic factor in multivariate analysis ( 22 – 29 , 31 , 32 , 39 ).…”

Prognostic Value of Albumin to Globulin Ratio in Non-Metastatic and Metastatic Prostate Cancer Patients: A Meta-Analysis and Systematic Review

“…Of the four articles selected for the review [ 18 , 19 , 20 , 21 ], all studies were retrospective mono or multicenter clinical trials ( Table 1 ).…”

“…All these studies defined the patient population in terms of clinical (age, PSA values), pathologic characteristics (staging, histologic grading) and progression (mainly biochemical (BCP)) after treatments. Two retrospective analyses [ 19 , 20 ] included non-metastatic PC cases considered for radical prostatectomy (RP), one [ 18 ] metastatic PC submitted to androgen deprivation therapies (ADT) and one [ 21 ] non-metastatic PC submitted to salvage RP after radiation therapy ( Table 1 ).…”

“…All four retrospective analyses [ 18 , 19 , 20 , 21 ] identified an optimal cut-off value for AGR so as to stratify the population between Low and High AGR groups. The AGR cut-off value was determined by receiver operating characteristics curve analysis, and the optimal cut-off in the different courts was similar, ranging from 1.31 to 1.53.…”

“…A meta-analysis suggested that a low preoperative serum albumin to globulin ratio (AGR) is related to worse prognosis in different human neoplasms [ 12 ]. Some retrospective analyses described a prognostic value for AGR in PC patients, as well [ 18 , 19 , 20 , 21 ].…”