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. 2017 Jan 15;8(2):258-265.
doi: 10.7150/jca.16525. eCollection 2017.

Preoperative Albumin to Globulin Ratio (AGR) as Prognostic Factor in Renal Cell Carcinoma

Xiaobo He  1 , Shengjie Guo  2 , Dong Chen  2 , Guangwei Yang  3 , Xin Chen  2 , Yijun Zhang  4 , Qiuming He  2 , Zike Qin  2 , Zhuowei Liu  2 , Yunfei Xue  5 , Meng Zhang  5 , Ruiwu Liu  6 , Fangjian Zhou  2 , Hui Han  2 , Kai Yao  2
Affiliations

Preoperative Albumin to Globulin Ratio (AGR) as Prognostic Factor in Renal Cell Carcinoma

Xiaobo He et al. J Cancer. .

Abstract

Background: Malnutrition and systemic inflammatory response are frequently associated with prognosis in patients with several types of cancer, including renal cell carcinoma (RCC). The study is aimed to investigate the ability of preoperative serum albumin to globulin ratio (AGR) to predict the long-term mortality of RCC patients. Methods: The study is a retrospective study of an unselected cohort of 895 RCC patients who underwent a curative radical or partial nephrectomy at the Department of Urology in the Sun Yat-Sen University Cancer Center between January 2000 and December 2012 and had documented preoperative serum total protein and albumin (ALB) levels. The preoperative AGR was calculated as the ratio of ALB to (total protein-ALB) and its association with other clinical indices was assessed using survival analysis. Results: Low preoperative AGR was associated with older population, lower hemoglobin, higher total protein, lower ALB, lower body mass index and advanced stage. The univariate and multivariate Cox analyses demonstrated that preoperative AGR was an independent prognostic indicator of overall survival (OS) (hazard ratio (HR): 0.63, 95% confidence interval (CI): 0.43 to 0.93, P=0.022). In addition, patients with low preoperative AGR at pT1-2, pT3-4, pN0, pN1, pM0 and pM1 stages had significantly shorter OS than patients with high preoperative AGR. Conclusion: Preoperative AGR is a proven objective, reproducible, inexpensive survival predictor of RCC patients following surgical resection and should be considered for routine clinical use.

Keywords: Albumin to Globulin ratio.; Albumin, Total Protein; Renal Cell Carcinoma.

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Conflict of interest statement

Conflicts of interest: All the authors state they have no conflicts of interest.

Figures

Figure 1
Figure 1
The receiver operating characteristic (ROC) curve for the preoperative albumin to globulin ratio (AGR).
Figure 2
Figure 2
Kaplan-Meier curves depicting overall survival (OS) according to the preoperative optimal value of albumin to globulin ratio (AGR) in patients with renal cell carcinoma.
Figure 3
Figure 3
Kaplan-Meier curves showing overall survival (OS) according to the preoperative optimal value of albumin to globulin ratio (AGR) in all patients with renal cell carcinoma. Patients were stratified according to the pT-status, pN-status, and pM-status. (A) Kaplan-Meier analysis of OS in pT1-2 subgroup. (B) Kaplan-Meier analysis of OS in pT3-4 subgroup. (C) Kaplan-Meier analysis of OS in pN0 subgroup. (D) Kaplan-Meier analysis of OS in pN1 subgroup. (E) Kaplan-Meier analysis of OS in pM0 subgroup. (F) Kaplan-Meier analysis of OS in pM1 subgroup.
See this image and copyright information in PMC

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