Prognostic significance of the albumin-to-globulin ratio for upper tract urothelial carcinoma
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RESEARCH ARTICLE
Open Access
Prognostic significance of the albumin-toglobulin ratio for upper tract urothelial carcinoma Shota Omura1, Satoru Taguchi1* , Shogo Miyagawa1, Ryuki Matsumoto1, Mio Samejima1, Naoki Ninomiya1, Kazuki Masuda1, Yu Nakamura1, Tsuyoshi Yamaguchi1, Manami Kinjo1, Mitsuhiro Tambo1, Takatsugu Okegawa1, Eiji Higashihara2 and Hiroshi Fukuhara1
Abstract Background: Although the albumin-to-globulin ratio (AGR) is a promising biomarker for various malignancies, few studies have investigated its prognostic significance for upper tract urothelial carcinoma (UTUC). Methods: This retrospective study conformed to the REporting recommendations for tumour MARKer prognostic studies (REMARK) guideline. We reviewed 179 patients with UTUC who underwent radical nephroureterectomy at our institution between 2008 and 2018. Associations of preoperative clinicopathological factors, including the AGR, with cancer-specific survival (CSS) and overall survival (OS) were assessed. The Cox proportional hazards model was used for univariate and multivariable analyses. AGR was dichotomized as < 1.25 and ≥ 1.25, according to the most discriminatory cutoff determined from the receiver operating characteristic curve analysis. Results: During a median follow-up of 34 months after surgery, 37 patients died from UTUC and 13 died of other causes. The preoperative AGR significantly correlated with pathological T stage, pathological N stage, and adjuvant chemotherapy. Multivariate analyses demonstrated that a decreased (< 1.25) preoperative AGR was an independent poor prognostic factor for both CSS (hazard ratio [HR] = 2.81, P < 0.01) and OS (HR = 2.09, P < 0.05). Conclusions: Preoperative AGR < 1.25 might serve as a useful prognostic marker for patients with UTUC undergoing radical nephroureterectomy. Keywords: AGR, Albumin-to-globulin ratio, Biomarker, Radical nephroureterectomy, REMARK, Upper tract urothelial carcinoma
Background Upper tract urothelial carcinoma (UTUC) is a relatively rare malignancy that accounts for 5–10% of urothelial carcinomas and generally has a poor prognosis [1, 2]. Radical nephroureterectomy with bladder cuff excision is the gold standard treatment for nonmetastatic UTUC
* Correspondence: [email protected] 1 Department of Urology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan Full list of author information is available at the end of the article
[3], whereas up to 19% of patients with UTUC have metastasis upon initial presentation [4]. Clinicopathological factors [5–15] including laboratory markers [11–15] serve as prognostic markers for UTUC. In contrast, the significance of the albumin-to-globulin ratio (AGR), which serves as a useful biomarker for various malignancies [16–26], has not been fully investigated in UTUC [23–26]. Therefore, the present study assessed the significance of the association of preoperative AGR on oncological outcomes of patients with UTUC undergoing radical nephroureterectomy.
© The Author(s). 2020 Open Access This article
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