Abstract
ObjectiveSerum albumin-to-alkaline phosphatase ratio (AAPR) has been proven to be a prognostic indicator of many malignant tumors. However, whether it can predict the prognosis of bladder cancer (BC) patients who underwent radical cystectomy (RC) remains unclear. This study was designed to assess the relationship between AAPR and clinical outcomes in patients with BC treated with RC.MethodsThe clinicopathological data of 199 BC patients receiving RC in our institution from January 2012 to December 2017 were retrospectively collected and analyzed. They were divided into three groups based on the optimal cut-off values and the association between AAPR groups and their clinical outcomes were evaluated.ResultsThe average age of the patients was (64.0 ± 8.7) years and 79.9% were male. Based on the cut-off values of AAPR, patients were divided into three groups: low-AAPR group (AAPR < 0.37, n = 35), medium-AAPR group (AAPR = 0.37-0.59, n = 61) and high-AAPR group (AAPR > 0.59, n = 103). The median overall survival (OS) of each AAPR group was 12.5, 24, and 29 months, respectively (P value <0.0001). After adjusting the Cox proportional hazards model, medium- and high- AAPR groups showed a reduced risk trend of death, with a risk ratio of 0.44 (95% CI = 0.21-0.91) and 0.25 (95% CI = 0.12-0.49), respectively (P for trend <0.001). No nonlinear relationship was identified by smooth fitting curve between AAPR and OS. By subgroup analysis, we observed that compared to the low-AAPR group, the trends of the HRs in the medium- and high-AAPR group were decreased across nearly all subgroups after stratification. Moreover, the AAPR-based nomograms for OS, CSS and RFS were also constructed. The C-index showed a good predictive accuracy (OS, C-index 0.728, 95% CI 0.663-0.793; CSS, C-index 0.792, 95% CI 0.748-0.838; RFS, C-index 0.784, 95% CI 0.739-0.829).ConclusionPretreatment AAPR is significantly associated with the prognosis of BC patients receiving RC, which can be conducive to the clinical decision-making and risk stratification in those patients. The nomogram based on AAPR is a reliable model for predicting survival of BC patients after RC.
Highlights
Bladder cancer (BC) is one of the most prevalent urological cancers all around the world, with an increasing rate of morbidity and mortality [1]
Based on the cut-off value of alkaline phosphatase ratio (AAPR) calculated by the X-tile software, patients were divided into three groups: low-AAPR group (AAPR < 0.37, n = 35), medium-AAPR group (AAPR = 0.37-0.59, n = 61) and high-AAPR group (AAPR > 0.59, n = 103)
No significant differences were detected in age, sex, smoking history, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), diabetes, hypertension, chemotherapy, American Society of Anesthesiologists (ASA) classification, T-stage, lymph node status, tumor grade and HGB among different AAPR groups
Summary
Bladder cancer (BC) is one of the most prevalent urological cancers all around the world, with an increasing rate of morbidity and mortality [1]. According to the depth of tumor infiltration into the bladder wall, BC can be categorized into two types: non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC), with about 25% of BC being MIBC at first diagnosis. Local or distant metastases occur in 15% of patients; in addition, approximately 30% to 40% of MIBC cases develop lymph node or distant metastases during the course of the disease [3]. Radical cystectomy (RC) produces relatively longterm survival rates in high-risk BC patients, the risk of local recurrence and distant metastasis is high and the prognosis is poor in these patients [4]. About 50% of high-risk patients will have distant metastasis and the 5-year survival rate is only 40%-60% [5]
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