Value Of Albumin-globulin Ratio Research Articles

Association of albumin, globulin and albumin/globulin ratio with renal injury in type 2 diabetic nephropathy patients

BackgroundStudies have shown that albumin/globulin ratio (AGR) can assess the extent of kidney damage in type 2 diabetic nephropathy (T2DN). However, there is a lack of similar clinical data to support this.ObjectivesThis study sought to inquire into the correlation of albumin (ALB), globulin (GLB) and albumin/globulin ratio (AGR) with renal injury in patients with type 2 diabetes mellitus (T2DM).MethodsA retrospective analysis was performed on the clinical data of 82 patients with T2DM (Control group) and 110 patients with type 2 diabetic nephropathy (T2DN) who were admitted to the First Affiliated Hospital of Wannan Medical College from October 2019 to April 2022. T2DN patients were classified into mild renal impairment group (n = 75) and moderate renal impairment group (n = 35) according to urinary albumin excretion rate (UAER). Then, the general data of all groups were compared. Furthermore, Pearson correlation was used to analyze the correlation of serum ALB, GLB and AGR with UAER in the three groups. A receiver operating characteristic curve (ROC) was utilized to evaluate the diagnostic value of ALB, GLB and AGR for moderate renal injury in T2DN patients.ResultsThere were significant differences in course of disease, history of hypertension, levels of fasting plasma glucose and glycosylated hemoglobin among the three groups. Besides, compared with the Control group, the levels of ALB and AGR were lower while GLB levels were higher in the mild and moderate renal impairment group. In particular, ALB and AGR levels were lower in the moderate renal impairment group relative to the mild renal impairment group, but the GLB levels exhibited no significant difference between the two groups. According to the results of Pearson correlation analysis, a negative correlation of ALB and AGR levels with UAER was revealed in T2DN patients. ROC curves displayed the area under the curve (AUC) of ALB (0.88) and AGR (0.71) predicting moderate renal injury in T2DM patients (p < 0.05). However, GLB has no significant diagnostic value for moderate renal injury in patients with T2DN.ConclusionThe course of disease, hypertension and glycemic control may affect the occurrence and development of T2DN. ALB and AGR are of high value in predicting renal injury in patients with T2DN and can serve as the foundation for the clinical diagnosis of the condition.

Evaluation of Serum Albumin and Globulin in Combination With C-Reactive Protein Improves Serum Diagnostic Accuracy for Low-Grade Periprosthetic Joint Infection

BackgroundSerum immune markers can be useful in the diagnosis of periprosthetic joint infection (PJI) by detecting long-lasting abnormal immunological conditions. The purpose of this study was to examine whether serum immune markers can improve the diagnostic accuracy of PJI. MethodsWe enrolled 51 PJI, 45 aseptic loosening, and 334 osteoarthritis patients for assessment of the discriminatory accuracy of serum markers including white blood cell count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and D-dimer, total protein, albumin (Alb), globulin (Glb), neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, albumin-globulin ratio (AGR), CRP-albumin ratio (CAR), and CRP-AGR ratio (CAGR). These diagnostic accuracies for low-grade PJI were also calculated in patients who had serum CRP levels < 10 mg/L. ResultsAmong serum markers, Alb, Glb, AGR, CRP, ESR, CAR, and CAGR had highly accurate diagnostic accuracy for PJI, with area under the curve of 0.92, 0.90, 0.96, 0.97, 0.92, 0.97, and 0.98, respectively. In low-grade PJI patients, area under the curve of CRP, ESR, CAR, and CAGR (0.69, 0.80, 0.65, and 0.82, respectively) was decreased but that of Alb, Glb, and AGR (0.90, 0.88, and 0.95, respectively) remained high, indicating the diagnostic utility of these immune markers. The sensitivity and specificity of AGR with cutoff value of 1.1 were demonstrated as 0.92 and 0.89, respectively, and with cutoff value of 1.2, 1.00, and 0.79, respectively, in the diagnosis of low-grade infection. ConclusionOur results demonstrate the potential value of Alb, Glb, AGR, and combination indices of these immune makers with CRP in improving preoperative serum diagnosis for PJI, especially in low-grade PJI. Level of EvidenceDiagnostic- Level II.

The Predictive Value of Preoperative Albumin-Globulin Ratio for Systemic Inflammatory Response Syndrome After Percutaneous Nephrolithotomy.

PurposeThis study aimed to assess the predictive value of preoperative albumin–globulin ratio (AGR) for systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL).MethodsPatients who underwent PCNL in Guizhou Provincial People’s hospital between August 2017 and July 2019 were enrolled and retrospectively reviewed. The primary clinical outcome of the current study was the development of SIRS within 48h after PCNL. Univariable and multivariable logistic regression analyses were conducted to verify the predictive value of AGR for post-PCNL SIRS. In addition, receiver operating characteristic (ROC) curves were generated to compare the discriminatory ability of AGR with other inflammatory biomarkers.Results354 patients who underwent PCNL were enrolled and 66 patients (18.64%) developed postoperative SIRS. None of the patients suffered postoperative sepsis in our study. Multivariate analysis demonstrated that female sex (odds ratio [OR]=2.939, 95% odds ratio [OR]: 1.368–6.315, p = 0.006), CRP (OR = 1.008, 95% CI: 1.003–1.012, p = 0.001), and AGR (OR = 0.048, 95% CI: 0.010–0.239, p < 0.001) were all independent predictors for SIRS after PCNL. The optimal cut-off value of AGR for predicting postoperative SIRS was 1.145. In addition, AGR had a higher area under the curve (0.844) with sensitivity of 83.3% and specificity of 88.9% than C-reactive protein (0.808).ConclusionPreoperative AGR is a potential predictor for SIRS development after PCNL.

The Prognostic Value of Albumin-Globulin Ratio and Eosinophil-Neutrophil Ratio in Patients with Advanced Tumors Undergoing Treatment with PD-1/PD-L1 Inhibitors

We investigated the prognostic value of peripheral serum biomarkers, including albumin-globulin ratio (AGR) and eosinophil-neutrophil ratio (ENR), in patients with advanced tumors treated with PD-1/PD-L1 inhibitors. We also retrospectively analyzed the clinical efficacy of PD-1/PD-L1 inhibition in 95 patients with advanced tumors treated at our center. The prognostic value of baseline AGR, baseline ENR, and baseline neutrophil-lymphocyte ratio (NLR) in the serum were evaluated. We also developed a risk scoring tool to stratify patients based on their prognosis. Univariate Cox regression analysis revealed that age, NLR, Eastern Cooperative Oncology Group (ECOG) performance status (PS), platelet-neutrophil ratio (PLR), ENR, AGR, lactate dehydrogenase levels, treatment line, and treatment type were correlated with progression-free survival (PFS). Multivariate Cox regression analysis showed that age, AGR, ENR, and treatment type were independent prognostic factors for PFS. Patients in the low-risk group had significantly longer PFS than those in the high-risk group. The nomogram concordance index (C-index) was 0.716. Patients with a decrease in AGR of over 20% after the first and second treatment cycles had significantly worse PFS than those without decreased AGR. These findings suggest that baseline AGR and ENR may be useful prognostic biomarkers for patients with advanced tumors treated with PD-1/PD-L1 inhibitors.

Correlation between Preoperative Serum Albumin-Globulin Ratio and Prognosis of Patients Undergoing Low Rectal Cancer Surgery.

To explore the correlation between preoperative serum albumin-globulin ratio (AGR) and the prognosis of patients undergoing low rectal cancer surgery. A total of 152 patients treated from June 2013 to June 2015 were selected. They were divided into survival group (n = 128) and death group (n = 24). Their general clinical data and preoperative and postoperative serum albumin (ALB), globulin (GLB) levels, and AGR were compared. Multivariate logistic regression analysis was performed for influencing factors for postoperative death. A nomogram prediction model was established based on independent risk factors. The predictive value of AGR for clinical outcomes was analyzed by receiver operating characteristic (ROC) curve, and the optimal cut-off value was obtained. The correlation between AGR and postoperative clinical outcomes was analyzed. The patients were divided into group A and B according to cut-off value, survival curves were plotted by Kaplan-Meier method, and 5-year survival rates were compared. There were significant differences in tumor stage, cell differentiation, depth of tumor invasion, lymph node metastasis, chemotherapy, preoperative ALB, GLB, and AGR between the two groups, which were all independent risk factors for death. After operation, ALB and AGR significantly declined and were significantly lower in the death group than those in the survival group. The death group had significantly higher GLB level than that of the survival group. The optimal cut-off value of AGR for predicting death was 1.73. AGR was significantly correlated with postoperative clinical outcomes. The survival rate of patients with AGR > 1.73 significantly exceeded that of cases with AGR ≤ 1.73. The preoperative serum AGR is an independent risk factor for the postoperative clinical outcomes of patients with low rectal cancer and has a high predictive value. Lower AGR indicates higher risk of postoperative death.

Evaluation and validation of the prognostic value of serum albumin to globulin ratio in patients with cancer cachexia: results from a large multicenter collaboration

Rationale: Recently, albumin-globulin-ratio (AGR), a serological indicator that reflects nutritional status and systemic inflammatory, has been reported to be associated with the prognosis of various cancers (1,2). However, there is currently no research report on its relationship with cancer cachexia. This study aimed to explore the prognostic value of AGR in patients with cancer cachexia through a multi-center retrospective analysis.

Evaluation and Validation of the Prognostic Value of Serum Albumin to Globulin Ratio in Patients With Cancer Cachexia: Results From a Large Multicenter Collaboration.

BackgroundRecently, albumin–globulin ratio (AGR), a serological indicator that reflects nutritional status and systemic inflammatory, has been reported to be associated with the prognosis of various cancers. However, there is currently no research report on its relationship with cancer cachexia.ObjectivesThis study aimed to explore the prognostic value of AGR in patients with cancer cachexia through a multicenter retrospective analysis.MethodsWe recruited 2,364 patients with cancer cachexia and randomly divided the patients into training and validation cohorts at a ratio of 7:3. The optimal stratification method was used to determine the optimal cutoff value of AGR. The survival curve was evaluated by the Kaplan–Meier method. Cox regression proportional-hazards model was used to determine independent prognostic factors in patients with cancer cachexia. The time-dependent receiver operating characteristic curve was used to compare the prognostic performance of different malnutrition evaluation tools.ResultsThe optimal cutoff value of AGR is 1.24 in patients with cancer cachexia. Increasing AGR was associated with survival in a dose–response manner with a forward L-shape. Compared with the high AGR group, the low AGR group had a shorter overall survival; and there was consistency in training and validation cohorts. In the stratified analysis of TNM stage, AGR has good prognostic distinguishing ability for advanced patients. Multivariate survival analysis determined that low AGR was an independent risk factor affecting all-cause mortality in patients with cancer cachexia. In addition, compared with other malnutrition evaluation tools, AGR could effectively stratify the prognosis of patients with cancer cachexia.ConclusionAGR was an independent prognostic factor affecting patients with cancer cachexia, especially in advanced patients. Compared with other malnutrition evaluation tools, AGR can effectively stratify the prognosis of patients with cancer cachexia.

The relation between inflammation-based parameters and survival in metastatic pancreatic cancer.

We aimed to evaluate whether tumor markers and inflammation parameters effect on survival in patients with metastatic pancreatic cancer (MPC). This retrospective analysis included 170 patients with pancreatic cancer who were admitted to the oncology clinic at the metastatic stage. Basic patient demographic characteristics, chemotherapy (CT) that patients received in the first line, complete blood count, neutrophil/lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), albumin/globulin ratio (AGR), prognostic nutritional index (PNI), tumor markers (carcinoembryonic antigen [CEA], carbohydrate antigen 19-9 [CA19-9]), and survival were analyzed. Receiver operating characteristic analysis was used to determine the optimum cutoff value of NLR, PLR, AGR, PNI, CEA, and CA 19-9, which could predict survival. The median age of the patients was 63 years (range, 33-87). About 63.5% of the patients were male and 44.5% were female. 161 (94.7%) patients died, and the median overall survival (OS) was 8.0 months (95% confidence interval = 6.6-9.4) for all patients. In univariate analysis, age (P < 0.001), CT regime (P < 0.002), AGR (P < 0.006), PNI (P < 0.017), NLR (P < 0.001), PLR (P < 0.062), and CA19-9 (P < 0.002) were statistically significant. In multivariate analysis, age (hazard ratio [HR] 1.534 95% 1.079-2.182 P < 0.017) CA19-9 (HR1.410 95% 1.001-1.989, P ≤0.005) and, NLR (HR 1.569 95% 1.001-2.463, P < 0.049) were significant. We determined, age, CA19-9, and basal high NLR as independent adverse prognostic factors for OS in APC. Fluorouracil, leucovorin, irinotecan, and oxaliplatin CT resulted in a significant increase in OS.

Prognostic value of the albumin-globulin ratio and albumin-globulin score in patients with multiple myeloma.

ObjectiveThe albumin–globulin ratio (AGR) has been identified as a promising prognostic predictor of mortality in patients with hematological malignancies. This study investigated the prognostic significance of AGR in patients with multiple myeloma.MethodsTwo hundred patients diagnosed with multiple myeloma from January 2010 to October 2018 were retrospectively analyzed and followed up until December 2019. Kaplan–Meier curves and multivariate Cox regression analysis were applied to detect the prognostic value of AGR.ResultsThe median follow-up period was 36 months. The optimal cutoff of AGR was 1.16 according to receiver operating characteristic curve analysis. High AGR was significantly correlated with better overall survival (OS) and progression-free survival (PFS). Multivariate analysis revealed that low AGR was an independent prognostic factor for worse OS (hazard ratio [HR] = 1.82, 95% confidence interval [CI] = 1.15–2.94) and PFS (HR = 1.53, 95% CI = 1.09–2.17).ConclusionsAGR may represent a potential prognostic biomarker in patients with multiple myeloma.Mini : We demonstrated that high AGR was associated with a favorable overall survival and progression-free survival in patients with multiple myeloma.

Retrospective study on the potential of albumin/globulin ratio as a prognostic biomarker for oral cavity cancer patients.

Although the serum albumin/globulin ratio (AGR) is recognized as a valuable prognostic biomarker in various cancers, its clinical value in oral cavity squamous cell carcinoma (OSCC) is still unclear. We aimed to probe the prognostic value of AGR in patients with OSCC undergoing curative surgery. This retrospective study analyzed 306 patients who were newly diagnosed as having OSCC and receiving curative surgery between 2008 and 2017. The correlation of AGR with survival outcomes was estimated using Cox proportional hazards models and Kaplan-Meier analysis. A nomogram based on AGR was established, and its accuracy was assessed according to the concordance index. The log rank test and Kaplan-Meier analysis indicated that patients who had low AGR had significantly shorter disease-free survival (DFS) as well as 5-year overall survival (OS) than those with high AGR. The multivariate Cox analysis revealed that low AGR was an independent predictor of poor OS and DFS (adjusted hazard ratio [aHR] = 2.812; 95% CI 1.729-4.573; p < 0.001, and aHR = 1.743; 95% CI 1.201-2.530; p = 0.003, respectively). The concordance index of the nomogram model based on TNM staging alone was 0.656 and could increase to 0.783 with the inclusion of AGR and other prognostic variables in the calculation. Preoperative AGR may represent an accessible, valuable prognostic biomarker in patients with OSCC. The nomogram model incorporating AGR and clinicopathological prognostic variables may improve the accuracy of prognostic predictions in these patients.

Serum albumin levels and serum albumin-globulin ratio are associated with poor prognosis in glioblastoma.

BackgroundSerum albumin levels (ALB) and albumin-globulin ratio (AGR) are reliable and convenient markers of the nutritional status and inflammation of human body, and ALB has been identified as a prognostic factor in the patients of glioblastoma (GBM). However, no literature has reported the prediction value of AGR for GBM.MethodsIn this study we evaluate the serum ALB and AGR levels for GBM. A total of 126 patients with GBM who underwent surgical resection in our institution between 2013 and 2017 were analyzed retrospectively. Clinical information was obtained from electronic medical records. Multiple logistic regression and Cox proportional hazards models were used to assess the prediction value of preoperative ALB and AGR for GBM.ResultsPreoperative ALB (HR 0.342, 95% CI, 0.123–0.954, P=0.040) and postoperative adjuvant therapy (HR 0.042, 95% CI, 0.005–0.330, P=0.003) were significantly related to progression-free survival (PFS). Cox regression analysis showed the significance of adjuvant therapy (HR 3.579, 95% CI, 2.236–5.729, P<0.001). Preoperative AGR (HR 0.280, 95% CI, 0.103–0.763, P=0.013) and adjuvant therapy (HR 0.156, 95% CI, 0.047–0.513, P=0.002) were showed significance, and Cox regression analysis showed preoperative AGR (HR 1.810, 95% CI, 1.095–2.992, P=0.021) and adjuvant therapy (HR 4.702, 95% CI, 2.841–7.782, P<0.001) were independent predictors of overall survival (OS).ConclusionsThe ALB and AGR had significant predictive values for the prognosis of GBM; postoperative adjuvant treatment is also an independent predictor for the prognosis of GBM patients.

Preoperative Albumin Level Is Superior To Albumin-Globulin Ratio As A Predicting Indicator In Gastric Cancer Patients Who Underwent Curative Resection.

ObjectiveThe preoperative value of albumin level and albumin/globulin ratio (AGR) has been discovered to be a possibility for predicting gastric cancer. However, their predictive accuracy remains unknown. This study’s objective is to evaluate the predictive value of albumin, globulin and AGR in gastric cancer.MethodsA total of 3266 gastric cancer patients in our institution who underwent radical gastrectomy during the period from September 2008 to April 2015 were retrospectively analyzed. Levels of preoperative serum albumin and globulin were recorded. The optimal cut off points of albumin, globulin and AGR were calculated using X-tile software. The association of albumin and AGR with clinicopathological features and eventual prognosis was analyzed. The survival predictive accuracy and prognostic discriminatory ability among different variables were analyzed.ResultsThis study consisted of 2531 males (77.5%) and 735 females (22.5%). Ages ranged from 20 to 90, with a median age of 58.0 years. The optimal cut off values of albumin, globulin and AGR were set at 42.0, 28.2 and 1.80, respectively. Patients in the high albumin group and high AGR group were both associated with younger age, smaller tumor size, as well as earlier T and N stages. Univariate and multivariate analysis demonstrated that albumin level and AGR value were both significant prognostic factors, while globulin level was not. Furthermore, albumin level displayed a prognostic discriminatory ability and a predictive accuracy superior to that of AGR. The multivariate model based on albumin also revealed a superior predictive accuracy than that based on AGR.ConclusionPreoperative albumin level is superior to AGR value in the prediction of prognosis of gastric cancer.

Pretreatment low prognostic nutritional index and low albumin-globulin ratio are predictive for overall survival in nasopharyngeal cancer.

We designed this retrospective study to identify predictive value of prognostic nutritional index (PNI) and albumin-globulin ratio (AGR) in nasopharyngeal cancer patients (NPC). 95 non-metastatic NPC patients were included in the study. AGR was calculated as the absolute counts between albumin and globulin measurements. (Globulin values were obtained via excluding albumin counts from total protein counts). PNI was calculated using the following formula: [10 × serum albumin value (g/dL) + 0.005 × total lymphocyte count] in the peripheral blood (per mm3). The statistically significant cutoff value of PNI was identified as 45.45 (area under the curve (AUC): 0.636, p = 0.03) for overall survival. The 5-year OS rate for patients with PNI ≤ 45.45 and PNI > 45.45 were 52.9% and 79.0%, respectively. There were statistically significant difference between groups (p = 0.03).The statistically significant cutoff value of AGR was identified as 1.19 (AUC: 0.689, p < 0.01) for overall survival. The 5-year OS rate for patients with AGR ≤ 1.19 and AGR > 1.19 were 57.7% and 82.0%. There were statistically significant differences between the groups (p = 0.04). 5-year OS rate was 42.9% in the high-risk group (low-PNI and low-AGR patients), it was 80.3% in the intermediate group (low PNI and high AGR or high PNI and low AGR) and it was 80.9% in low-risk group (high PNI and high AGR) (p = 0.004). In the multivariate analysis, age and PNI were independent prognostic factors for poorer OS (HR 2.70, 95% CI 1.091-6.719, p = 0.32 and HR 2.44, 95% CI 1.009-5.940, p = 0.48). Low PNI is independent prognostic factor for poorer OS. Patients with low-PNI and low-AGR have worse survival than patients with high PNI and high AGR.

The prognostic value of serum albumin-globulin ratio in early-stage non-small cell lung cancer: a retrospective study.

Background: Previous studies demonstrated a significant association between the albumin–globulin ratio (AGR) and various types of cancers. The aim of this study was to evaluate the prognostic value of preoperative AGR in patients with early-stage non-small cell lung cancer (NSCLC).Methods: Patients diagnosed as NSCLC in a single center between January 1, 2014 and February 29, 2016 were retrospectively reviewed. AGR was defined as the ratio between the serum albumin level and the serum globulin level. Receiver operating characteristics analysis was performed to determine optimal cutoff values. Overall survival (OS) and disease-free survival (DFS) were clinical outcomes of our study. Univariate and multivariate Cox regression analyses were used to identify independent prognostic factors, and the Kaplan–Meier method was used to estimate survival curves.Results: A total of 279 early stage NSCLC patients were enrolled in our study with the median follow-up of 39 months (range 1–56 months). The statistical analyses manifested that the age (hazard ratio (HR)=1.045, 95% confidence interval (95% CI): 1.010–1.081, P=0.011) and AGR <1.51 (HR=3.424, 95% CI: 1.600–7.331, P=0.002) were independent prognostic factors for OS; larger tumor (HR=1.211, 95% CI: 1.011–1.450, P=0.038) and AGR <1.51 (HR=2.177, 95% CI: 1.052–4.508, P=0.036) were significantly associated with decreased DFS.Conclusion: The current research reported that the preoperative AGR was an independent prognostic factor for both OS and DFS in early NSCLC, and patients with AGR <1.51 were more likely to have a poor prognosis.

Pretreatment serum albumin/globulin ratio as a prognostic biomarker in metastatic prostate cancer patients treated with maximal androgen blockade.

The pretreatment serum albumin/globulin ratio (AGR) has been used as a prognostic biomarker for various cancer types. However, the prognostic value of the AGR for prostate cancer, especially for metastatic prostate cancer (mPCa) after maximal androgen blockade (MAB), remains unclear. The aim of this study was to evaluate the prognostic value of the pretreatment serum AGR for mPCa treated with MAB. This retrospective study included 214 mPCa patients receiving MAB from October 2007 to March 2017. The correlation of the AGR with survival was estimated using Kaplan–Meier analysis and Cox proportional hazards models. The cutoff value of the AGR was 1.45 according to the receiver operating characteristic curve. Kaplan–Meier analysis demonstrated that patients with a low AGR (<1.45) had poor outcomes in terms of progression-free survival (PFS) and cancer-specific survival (CSS). Multivariate Cox analyses showed that the AGR was an independent predictor of PFS (hazard ratio [HR] = 0.642; 95% confidence interval [CI]: 0.430–0.957; P = 0.030) and CSS (HR = 0.412; 95% CI: 0.259–0.654; P < 0.001). Furthermore, in a subset of 79 patients with normal serum albumin levels (≥40.0 g l−1), the serum AGR remained an independent predictor of CSS (P = 0.009). The pretreatment AGR was an independent prognostic biomarker for PFS and CSS in patients with mPCa receiving MAB. In addition, the AGR remained effective for the prediction of CSS in patients with normal albumin levels (≥40 g l−1). However, further prospective studies are needed to confirm our conclusions.

Prognostic value of pretreatment albumin/globulin ratio in digestive system cancers: A meta-analysis.

The albumin/globulin ratio (AGR) has been widely reported to be a potential predictor of prognosis in digestive system cancers (DSCs), but convincing conclusions have not been made. Therefore, herein, we performed a meta-analysis of relevant studies regarding this topic to evaluate the prognostic value of AGR in patients with DSCs. Three databases, including PubMed, EMBase, and Web of science, were searched comprehensively for eligible studies through September 8, 2017. The outcomes of interest included overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS). In our meta-analysis, pooled analysis of 13 studies with 9269 patients showed that a low AGR was significantly correlated with poor OS (HR = 1.94; 95% CI: 1.57–2.38; P <0.001). Five studies with 6538 participants involved DFS, and our pooled analysis of these studies also demonstrated that there was a significant association of a low AGR with worse DFS (HR = 1.49; 95% CI: 1.10 to 2.00; P < 0.001). In addition, only 2 studies referred to CSS, and we also detected a significant relationship between a low AGR and worse CSS from the results of our meta-analysis. In summary, a low pretreatment AGR was related to unfavorable survival in human digestive system cancers. A low pretreatment AGR may be a useful predictive prognostic biomarker in human digestive system cancers.

The prognostic value of preoperative serum albumin-globulin ratio for high-grade bladder urothelial carcinoma treated with radical cystectomy: A propensity score-matched analysis.

Albumin-globulin ratio (AGR) has been reported as an independent risk factor for survival outcomes of a variety of malignancies. We aimed to further examine the prognostic value of AGR for urothelial carcinoma of bladder (UCB) using a propensity score-matched (PSM) analysis. The medical data of 189 high-grade UCB patients undergoing radical cystectomy were retrospectively reviewed. AGR was defined as the ratio of serum albumin to nonalbumins (serum total protein-albumin). The association of preoperative AGR with clinicopathologic characteristics and prognosis were assessed. Multivariate analyses using Cox regression models were applied to evaluate the independent prognostic factors. The receiver operating curve analysis indicated 1.55 as the optimal cutoff value to define low or high AGR. In prematched cohorts, Kaplan-Meier analysis indicated that AGR lower than 1.55 was associated with poorer overall survival (OS), progression-free survival (PFS), and tumor-specific survival (TSS) (P < 0.001 for all). Multivariable cox analyses also showed that AGR lower than 1.55 were an independent risk factor for survival outcomes, including OS, PFS, and TSS (P < 0.01 for all). In particular, AGR lower than 1.55 remained its prognostic value after PSM analysis. Low AGR was a significant unfavorable factor for UCB patients treated with radical cystectomy. This viable parameter should be enrolled in the pretreatment risk stratification for UCB.

Prognostic significance of pretreatment albumin/globulin ratio in patients with hepatocellular carcinoma.

BackgroundPretreatment nutritional and immunological statuses play an indispensable role in predicting the outcome of patients with various types of malignancies. The purpose of this study is to evaluate the predictive value of albumin/globulin ratio (AGR) in overall survival (OS) and recurrence in patients with hepatocellular carcinoma (HCC) following radical hepatic carcinectomy.Patients and methodsThis retrospective study included a total of 172 patients with HCC with complete medical and follow-up information between 2002 and 2012. AGR was calculated according to the following formula: AGR = albumin/globulin. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff value. The associations of AGR with clinicopathological characteristics and prognosis were assessed. Further multivariate analysis using Cox regression model and subgroup analysis was performed to evaluate the predictive value.ResultsReceiver operating characteristic curve determined 37.65, 31.99, and 1.48 as the optimal cutoff values of albumin, globulin, and AGR in terms of 5-year OS or death, respectively. On the basis of the cutoff value of AGR, all the patients were divided, respectively, into low-AGR (n=105) and high-AGR (n=67) groups. AGR was found to be significantly correlated with age, cancer embolus, international normalized ratio, and postoperative outcome (P<0.05). Hepatitis B virus infection (hazard ratio [HR]: 2.125; 95% confidence interval [CI]: 1.285–3.153), tumor node metastasis stage (HR: 1.656; 95% CI: 1.234–2.223), serum albumin (HR: 0.546; 95% CI: 0.347–0.857), and AGR (HR: 0.402; 95% CI: 0.233–0.691) were independent predictors of OS via univariate and multivariate survival analyses. However, alpha-fetoprotein (HR: 1.708; 95% CI: 1.027–2.838), tumor node metastasis stage (HR: 1.464; 95% CI: 1.078–1.989), and AGR (HR: 0.493; 95% CI: 0.293–0.828) functioned as independent risk variables for predicting recurrence. Moreover, AGR showed superior prognostic value for OS and recurrence in the subgroups with normal level of albumin or survival time beyond 6 months.ConclusionPretreatment AGR might serve as an effective biomarker to evaluate the prognosis of patients with a diagnosis of HCC. Based on the results, AGR, characterized with easy accessibility, objectivity, and noninvasiveness, should be included in the routine assessment of HCC.

Pretreatment Albumin/Globulin Ratio Predicts the Prognosis for Small-Cell Lung Cancer.

The pretreatment albumin/globulin ratio (AGR) has been used as a prognostic factor in various cancers. This study aimed to evaluate the predictive value of AGR in small-cell lung cancer (SCLC).We tested albumin and total proteins in plasma samples from 276 SCLC patients from our cancer center between January 2003 and December 2006. The AGR was defined by the formula: albumin/(total proteins–albumin). The correlation between AGR and overall survival (OS) was examined by Kaplan–Meier and Cox regression methods. For validation, AGR was used to evaluate the prognosis of SCLC in another independent group.Total 276 patients (testing) and 379 patients (validation) were finally enrolled. The median OS was 15.31 months for testing patients and 15.06 months for validation patients, respectively. We determined 1.29 as the cutoff value by using the biostatistical tool (Cutoff Finder), then the patients in the testing group were classified into 2 groups. Kaplan–Meier curves showed high AGR group had significantly longer OS than low AGR group (P = 0.026). According to multivariate analyses, AGR was an independent prognostic factor for OS of SCLC patients in the testing group (HR, 1.35, 95% CI: 1.01–1.81, P = 0.046). In the validation group, AGR was also verified as a predictive factor for OS (P < 0.001), and the risk of SCLC in the low AGR group was 1.43 times higher than that in the high AGR group (HR, 1.43, 95% CI: 1.05–1.94, P = 0.022).AGR is an independent prognostic marker in SCLC patients. Furthermore, it could be of great value in the management of SCLC patients.

Prognostic Significance of Preoperative Albumin-Globulin Ratio in Patients with Upper Tract Urothelial Carcinoma.

BackgroundPreoperative albumin-globulin ratio (AGR) reflects both malnutrition and systemic inflammation in cancer patients. In particular, systemic inflammation has been reported to contribute to tumor progression and poor oncological outcome in various malignancies. However, the prognostic value of preoperative AGR in upper tract urothelial carcinoma (UTUC) has not been examined.MethodsWe retrospectively reviewed medical data of 187 operable UTUC patients in a Chinese cohort with a high incidence of chronic kidney disease (CKD). AGR was calculated as [AGR = albumin/(serum total protein—albumin)]. The associations of preoperative AGR with clinicopathologic characteristics and prognosis were assessed. Multivariate analyses using Cox regression models were performed to determine the independent prognostic factors.ResultsThe median (IQR) preoperative AGR was 1.50 (1.30–1.70), and the optimal cutoff value was determined to be 1.45 according to the receiver operating curve analysis. Low AGR was significantly associated with female gender, high CKD stage and tumor grade (P < 0.05). Eighty-three patients died before the follow-up endpoint. Kaplan-Meier analysis showed that an AGR < 1.45 predicted significantly poorer overall and cancer-specific survivals compared to an AGR ≥ 1.45 (P < 0.001 and P = 0.008, respectively). Multivariate analyses showed that an AGR < 1.45 was an independent risk factor for poorer overall and cancer-specific survivals (P = 0.002 and P = 0.015, respectively).ConclusionsPreoperative AGR can act as an effective biomarker with easy accessibility for evaluating the prognosis of patients with UTUC. AGR should be applied in UTUC patients for risk stratification and determination of optimal therapeutic regimens.