Albumin–globulin ratio (AGR) as independent predictor of poor survival in renal cell carcinoma: A systematic review and meta-analysis

Abstract

ABSTRACT Objective The concentration of albumin and globulin in the body can serve as indicators of both nutritional status and inflammation. The predictive significance of the albumin-to-globulin ratio (AGR) has been documented in multiple cancer types. Consequently, a meta-analysis was conducted in order to investigate the prognostic impact of AGR on survival outcomes among individuals diagnosed with renal cell carcinoma (RCC). Methods A systematic search was conducted across four electronic databases to identify pertinent studies that evaluated the predictive significance of pre-treatment albumin-to-globulin ratio (AGR) in patients with renal cell carcinoma (RCC). The main outcome of interest in this study was overall survival (OS), whereas additional outcomes included cancer-specific survival (CSS), progression-free survival (PFS), and disease-free survival (DFS). The researchers utilized random-effect models to summarize the time-to-event outcomes, presenting the results as adjusted hazard ratios (aHR) along with their corresponding 95% confidence intervals (CI). Results A total of 5,732 RCC patients in eight studies were included. Cut-off for AGR value varies among studies, with AGR higher than 1.1–1.47 regarded as normal. Pooled analysis from these studies showed that low AGR value was associated with shorter OS (aHR 1.84 (95% CI 1.35–2.51), p = 0.0001) and CSS (aHR 1.91 (95% CI 1.15–3.16), p = 0.01). Conclusions This study suggests the role of AGR in predicting the OS and CSS of RCC. AGR values can be used in the risk stratification of patients with RCC, where a low AGR value indicates poorer prognosis.