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. 2018 Oct 17:10:4695-4708.
doi: 10.2147/CMAR.S178271. eCollection 2018.

Preoperative albumin-to-globulin ratio as a significant prognostic indicator in urologic cancers: a meta-analysis

Yi Zhang  1 , Lijuan Wang  2 , Shibu Lin  3 , Rong Wang  1
Affiliations

Preoperative albumin-to-globulin ratio as a significant prognostic indicator in urologic cancers: a meta-analysis

Yi Zhang et al. Cancer Manag Res. .

Abstract

Background: Emerging studies reported that preoperative albumin-to-globulin ratio (AGR) correlated with tumor progression and prognosis in several types of cancer. The aim of this study was to systematically explore the association between preoperative AGR and clinical outcomes in cancers of the urinary system.

Methods: Relevant articles were searched in PubMed, Embase and Web of Science by two independent investigators from inception to June 1, 2018. Eligible studies were selected based on predetermined selection criteria. Summarized HRs or ORs and 95% CIs were calculated for prognosis and clinicopathologic features with the fixed-effects or random-effects models.

Results: Eight cohort studies comprising 2,668 patients were included for analysis. The pooled results showed that a low AGR significantly correlated with poor OS (HR: 0.38, 95% CI: 0.27-0.48, P<0.001), worse cancer-specific survival (CSS) (HR: 0.36, 95% CI: 0.22-0.50, P<0.001) and inferior event-free survival (EFS) (HR: 0.36, 95% CI: 0.25-0.48, P<0.001) in urologic cancers. In addition, patients in low and high AGR groups showed significant differences in lymphovascular invasion (P<0.001), pT status (P<0.001) and pN status (P<0.001).

Conclusion: Preoperative AGR might be a valuable, cheap and reproducible prognostic bio-marker in urologic cancers following surgical resection.

Keywords: albumin-to-globulin ratio; clinical features; prognosis; urologic cancer.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow diagram of the meta-analysis.
Figure 2
Figure 2
Meta-analysis of the relationship between AGR and OS. Abbreviations: AGR, albumin-to-globulin ratio; BC, bladder carcinoma; OS, overall survival; RCC, renal cell carcinoma; UTCC, upper tract urothelial carcinoma.
Figure 3
Figure 3
Meta-analysis of the relationship between AGR and CSS. Abbreviations: AGR, albumin-to-globulin ratio; BC, bladder carcinoma; CSS, cancer-specific survival; UTCC, upper tract urothelial carcinoma.
Figure 4
Figure 4
Meta-analysis of the relationship between AGR and EFS. Abbreviations: AGR, albumin-to-globulin ratio; DFS, disease-free survival; EFS, event-free survival; PFS, progression-free survival; RFS, recurrence-free survival.
Figure 5
Figure 5
Meta-analysis of the association between AGR and tumor grade. Abbreviation: AGR, albumin-to-globulin ratio.
Figure 6
Figure 6
Meta-analysis of the association between AGR and lymphovascular invasion. Abbreviation: AGR, albumin-to-globulin ratio.
Figure 7
Figure 7
Meta-analysis of the association between AGR and pT status. Abbreviation: AGR, albumin-to-globulin ratio.
Figure 8
Figure 8
Meta-analysis of the association between AGR and pN status. Abbreviation: AGR, albumin-to-globulin ratio.
Figure 9
Figure 9
Publication bias assessment for OS (A), CSS (B), EFS (C), tumor grade (D), LVI (E), pT (F) and pN (G). Abbreviations: CSS, cancer-specific survival; EFS, event-free survival; LVI, lymphovascular invasion; OS, overall survival.
Figure 10
Figure 10
Sensitivity analysis for OS (A), CSS (B), EFS (C), tumor grade (D), LVI (E), pT (F) and pN (G). Abbreviations: CSS, cancer-specific survival; EFS, event-free survival; LVI, lymphovascular invasion; OS, overall survival.
See this image and copyright information in PMC

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