Abstract
We conducted a multicenter clinical study to construct a novel index based on a combination of albumin-globulin score and sarcopenia (CAS) that can comprehensively reflect patients' nutritional and inflammatory status and assess the prognostic value of CAS in renal cell carcinoma (RCC) patients. Between 2014 and 2019, 443 patients from 3 centers who underwent nephrectomy were collected (343 in the training set and 100 in the test set). Kaplan-Meier curves were employed to analyze the impact of albumin-globulin ratio (AGR), albumin-globulin score (AGS), sarcopenia, and CAS on overall survival (OS) and cancer-specific survival (CSS) in RCC patients. Receiver operating characteristic (ROC) curves were used to assess the predictive ability of AGR, AGS, sarcopenia, and CAS on prognosis. High AGR, low AGS, and nonsarcopenia were associated with higher OS and CSS. According to CAS, the training set included 60 (17.5%) patients in grade 1, 176 (51.3%) patients in grade 2, and 107 (31.2%) patients in grade 3. Lower CAS was linked to longer OS and CSS. Multivariate Cox regression analysis revealed that CAS was an independent risk factor for OS (grade 1 vs. grade 3: aHR = 0.08; 95% CI: 0.01–0.58, p = 0.012; grade 2 vs. grade 3: aHR = 0.47; 95% CI: 0.25–0.88, p = 0.018) and CSS (grade 1 vs. grade 3: aHR = 0.12; 95% CI: 0.02–0.94, p = 0.043; grade 2 vs. grade 3: aHR = 0.31; 95% CI: 0.13–0.71, p = 0.006) in RCC patients undergoing nephrectomy. Additionally, CAS had higher accuracy in predicting OS (AUC = 0.687) and CSS (AUC = 0.710) than AGR, AGS, and sarcopenia. In addition, similar results were obtained in the test set. The novel index CAS developed in this study, which reflects patients' nutritional and inflammatory status, can better predict the prognosis of RCC patients.
Highlights
Renal cell carcinoma (RCC), alternatively referred to as renal cancer, is 1 of the most prevalent malignancies of the urinary system
This study aimed to determine the influence of albumin-globulin ratio (AGR), albumin-globulin score (AGS), and sarcopenia on the prognosis of RCC patients treated with laparoscopic nephrectomy and to build a novel index based on a combination of AGS and sarcopenia (CAS) that can more comprehensively reflect the nutritional and inflammatory status of RCC patients and investigate the prognostic ability of combination of albumin-globulin score and sarcopenia (CAS) in RCC patients undergoing laparoscopic nephrectomy
In training and test sets, we found that most patients were male, age
Summary
Renal cell carcinoma (RCC), alternatively referred to as renal cancer, is 1 of the most prevalent malignancies of the urinary system. It is common cancer with morbidity of 2–3% in systemic malignant tumors and 80–85% in renal cancers [1]. Due to its increasing incidence, 170,000 RCC patients died worldwide in 2018, with a mortality rate of ∼ 2.7% [2]. When RCC is early detected, it can be effectively treated with radical or partial nephrectomy, with a 5-year survival rate of 93% [3]. Advanced RCC patients have a decreased 5-year survival rate of 67% due to regional and distant metastases [5]
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