Abstract
In this retrospective analysis, we evaluated associations between albumin to globulin ratio (AGR), clinicopathological characteristics, and survival in 592 patients with localized or locally advanced clear cell renal cell carcinoma (CCRCC) prior to nephrectomy. We found that low AGR was associated with more aggressive tumor behavior; patients with low AGR had poorer overall survival (OS) and cancer-specific survival (CSS) in Kaplan-Meier survival analyses both before and after propensity score matching, which was used to compensate for differences in baseline clinicopathological characteristics. AGR was an independent prognostic factor for both OS (HR: 6.799; 95% CI: 3.215−14.377; P < 0.001) and CSS (HR: 8.806; 95% CI: 3.891−19.928; P < 0.001), and its prognostic value was higher than that of other established inflammation-based prognostic scores. When AGR was incorporated into a prognostic model that included T stage, neutrophil to lymphocyte ratio (NLR), and monocyte to lymphocyte ratio (MLR), the resulting nomogram predicted 3- and 5-year OS in the patients more accurately than when AGR was not included. In conclusion, AGR may be particularly useful for improving clinical outcome predictions for patients with localized or locally advanced CCRCC.
Highlights
Renal cell carcinoma (RCC) accounts for 2%–3% of adult malignancies, and is the second most common type of urogenital neoplasm after bladder cancer [1]
We found that low albumin to globulin ratio (AGR) was associated with more aggressive tumor behavior; patients with low AGR had poorer overall survival (OS) and cancer-specific survival (CSS) in Kaplan-Meier survival analyses both before and after propensity score matching, which was used to compensate for differences in baseline clinicopathological characteristics
The primary cohort consisted of a total of 258 men (62.0%) and 158 women (38.0%) with localized or locally advanced clear cell renal cell carcinoma (CCRCC) who underwent radical or partial nephrectomy. 154 (37.0%) of these patients were older than 60 years, and 262 (63.0%) were younger; the median age was 56.3 years
Summary
Renal cell carcinoma (RCC) accounts for 2%–3% of adult malignancies, and is the second most common type of urogenital neoplasm after bladder cancer [1]. Clear cell renal cell carcinoma (CCRCC) is the most common pathological subtype, accounting for 70%–80% of all RCC cases. As RCC is not sensitive to chemoradiotherapy, radical nephrectomy remains the most promising treatment for patients with localized or locally advanced RCC. In order to evaluate postoperative risks and to improve individualized treatment, several prognostic models based on clinicopathological characteristics, such as TNM stage [3] and Fuhrman grade [4], have been established to predict outcomes in RCC patients. Prognostic models based on clinicopathological characteristics alone are less effective for patients with localized or locally advanced CCRCC; a novel prognostic model is urgently needed to improve outcome predictions for these patients
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