Prognostic role of preoperative albumin to globulin ratio in predicting survival of clear cell renal cell carcinoma

Abstract

Purpose: To investigate the prognostic role of preoperative albumin/globulin ratio (AGR) in predicting disease-free survival (DFS) and overall survival (OS) in localized and locally advanced clear cell renal cell carcinoma (RCC) patients.

Patients and methods: 162 patients who met the criteria specified were included in the study. The DFS and OS ratios were determined using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the prognostic factors affecting DFS and OS.

Results: Median follow-up period was 27.5 (6-89) months. There was a statistically significant relationship between low AGR and high pathological tumor (pT) stage, presence of collecting system invasion, presence of tumor necrosis, and a high platelet count (p = 0.012, p = 0.01, p = 0.001, and p = 0.004, respectively). According to the Kaplan-Meier survival analysis, both OS and DFS were found to be significantly lower in the low AGR group (p = 0.006 and p = 0.012). In the multivariate Cox regression analysis, collecting system invasion and tumor necrosis were found to be independent prognostic factors in predicting OS and pT stage was found to be an independent prognostic factor in predicting DFS (HR: 4.08, p = 0.043; HR: 8.64, p = 0.003 and HR: 7.78, p = 0.041, respectively).

Conclusion: In our study, low AGR was found to be associated with increased mortality and disease recurrence in localized and locally advanced RCC.

Keywords: Albumins; Carcinoma, Renal Cell; Globulins.

Figure 1. Flow chart of patients who met study inclusion / exclusion criteria.

Figure 2. Optimal cut-off levels for (A) albumin / globulin ratio (AGR), (B) neutrophil / lymphocyte ratio, (c) platelet / lymphocyte ratio (PLR), and (D) lymphocyte /monocyte ratio(LMR) were applied with receiver operating characteristic (ROC) curves for overall survival.

Figure 3. Optimal cut-off levels for (A) albumin / globulin ratio (AGR), (B) neutrophil / lymphocyte ratio, (c) platelet / lymphocyte ratio (PLR), and (D) lymphocyte / monocyte ratio(LMR) were applied with receiver operating characteristic (ROC) curves for disease-free survival.

Figure 4. Kaplan–Meier curves predicting disease-free survival, and 2 and 5-year disease-free survival probability, groups categorized by the pretreatment (A) albumin / globulin ratio (AGR), (B) neutrophil / lymphocyte ratio (NLR), (c) platelet / lymphocyte ratio (PLR), and (D) lymphocyte / monocyte ratio (LMR)..

Figure 5. kaplan–Meier curves predicting overall survival, and 2 and 5-year overall survival probability, groups categorized by the pretreatment (A) albumin / globulin ratio (AGR), (B) neutrophil / lymphocyte ratio (NLR), (c) platelet / lymphocyte ratio (PLR), and (D) lymphocyte / monocyte ratio (LMR).