Albumin-to-alkaline phosphatase ratio as a promising indicator of prognosis in human cancers: is it possible?

Abstract

Background The impact of albumin-to-alkaline phosphatase ratio (AAPR) on prognosis in cancer patients remains uncertain, despite having multiple relevant studies in publication. Methods We systemically compiled literatures from 3 databases (Cochrane Library, PubMed, and Web of Science) updated to May 24th, 2020. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed and synthesized using STATA 14, values were then pooled and utilized in order to assess the overall impact of AAPR on patient’s prognosis. Results In total, 18 studies involving 25 cohorts with 7019 cases were incorporated. Pooled results originated from both univariate and multivariate analyses (HR = 2.14, 95%CI:1.83–2.51, random-effects model; HR = 1.93, 95%CI:1.75–2.12, fixed-effects model; respectively) suggested that decreased AAPR had adverse effect on overall survival (OS). Similarly, pooled results from both univariate and multivariate analysis of fixed-effects model, evinced that decreased AAPR also had adverse effect on disease-free survival (DFS) (HR = 1.81, 95%CI:1.60–2.04, I2 = 29.5%, P = 0.174; HR = 1.69, 95%CI:1.45–1.97, I2 = 13.0%, P = 0.330; respectively), progression-free survival (PFS) (HR = 1.71, 95%CI:1.31–2.22, I2 = 0.0%, P = 0.754; HR = 1.90, 95%CI:1.16–3.12, I2 = 0.0%, P = 0.339; respectively), and cancer-specific survival (CSS) (HR = 2.22, 95%CI:1.67–2.95, I2 = 5.6%, P = 0.347; HR = 1.88, 95%CI:1.38–2.57, I2 = 26.4%, P = 0.244; respectively). Admittedly, heterogeneity and publication bias existed, but stratification of univariate meta-analytic results, as well as adjusted meta-analytic results via trim and fill method, all showed that AAPR still significantly correlated with poor OS despite of confounding factors. Conclusions In summary, decreased AAPR had adverse effect on prognosis in cancer patients. As an inexpensive and convenient ratio derived from liver function test, AAPR might become a promising indicator of prognosis in human cancers.

Pretreatment Albumin-to-Alkaline Phosphatase Ratio Is a Prognostic Marker in Lung Cancer Patients: A Registry-Based Study of 7077 Lung Cancer Patients

“…A new prognostic index has been introduced that combines serum albumin and serum alkaline phosphatase, i.e., the albumin-to-alkaline phosphatase ratio (AAPR), and has been shown to have significant prognostic value in several types of cancer, especially in hepatocellular carcinoma [ 11 , 12 ]. Interestingly, the data indicate that combining these two prognostic markers can offer additional prognostic value as compared with the single markers [ 13 , 14 ].…”

Albumin-To-Alkaline Phosphatase Ratio as a Novel and Promising Prognostic Biomarker in Patients Undergoing Esophagectomy for Carcinoma: A Propensity Score Matching Study

“…Since Chan et al (16) first introduced this simply synthetic biomarker based on sALB and serum ALP for estimating the outcome of the procedure in hepatocellular carcinoma, AAPR has been widely demonstrated to be promisingly indicative of post-treatment prognosis in a series of malignant tumors, including nasopharyngeal carcinoma (17), urothelial carcinoma (18), cholangiocarcinoma (19), lung cancer (12,20), bladder cancer (21), and pancreatic cancer (22,23). Several recent evidence-based literature reviews have also provided comprehensive results suggesting a potent prognostic impact of AAPR in human solid tumors, regardless of their histological origins (15,24). However, until recently, there was no investigation aimed at the clinical significance of AAPR in surgically resected ESCC.…”

“…At the same time, sALB maintains its physiological properties as an antioxidant transporter. Therefore, hypoalbuminemia may impair antitumor immunity and response to adjuvant therapy, leading to unfavorable postsurgical prognosis (15). Secondly, serum ALP is a hydrolytic enzyme mainly concentrated in the liver, bone, and kidney that catalyze the hydrolytic processes and phosphate transfer in an alkaline environment.…”

“…Serum albumin (sALB), a traditional serum biochemical marker synthesized by the liver, has been widely used to reflect the nutritional reserve of the host and considered as a prognostic indicator for malignant tumors (12)(13)(14). Alkaline phosphatase (ALP), another hydrolase widely accepted as a disease marker of the hepatobiliary system, bone, and kidney, has also been correlated with postoperative survival of cancer patients (15). In summary, a novel and simple scoring system by integrating sALB with serum ALP, named albumin-toalkaline phosphatase ratio (AAPR), has been constantly validated as a reliable prognostic indicator across a wide range of malignant tumors, regardless of their treatment options (12,(16)(17)(18)(19)(20)(21)(22)(23)(24).…”

Biochemical changes associated with the administration of aqueous pulp extract of Irvingia gabonensis fruit on adult male Wistar rats

“…Also, the significant reduction in serum ALP activity by APEIG may perhaps indicate the absence of cholestasis (lack of bile flow). Alkaline phosphatase (ALP) is an important indicator of liver function test, whose elevation is universally recognized as a marker of hepatobiliary or skeletal diseases [38,39]. The non-significant decrease and increase observed in the level of AST may be an indication of the absence of liver damage, which may be associated with APEIG administration.…”