Albumin-to-alkaline phosphatase ratio serves as a prognostic indicator in unresectable pancreatic ductal adenocarcinoma: a propensity score matching analysis

Abstract

Background Recent evidence suggests that albumin-to-Alkaline Phosphatase Ratio (AAPR) functions as a novel prognostic marker in several malignancies. However, whether it can predict the prognosis of unresectable pancreatic ductal adenocarcinoma (PDAC) remains unclear. Herein, we seek to explore this possibility by a propensity score matching (PSM) analysis. Methods This was a retrospective design in which 419 patients diagnosed with unresectable PDAC and receiving chemotherapy were recruited. Patients were stratified based on the cutoff value of AAPR. The PSM analysis was used to identify 156 well-balanced patients in each group for overall survival (OS) comparison and subgroup analysis. Univariate and multivariate analyses were carried out to examine the potential of AAPR to indicate the prognosis of unresectable PDAC. Results We identified an AAPR of 0.4 to be the optimal cutoff for OS prediction. Patients with AAPR≤0.4 had significantly shorter OS compared with patients with AAPR>0.4 (6.4 versus 9.3 months; P<0.001). Based on the PSM cohort and entire cohort, multivariate Cox analysis revealed that high pretreatment for AAPR was an independent marker predicting favorable survival in unresectable PDAC (hazard ratio, 0.556; 95% confidence interval, 0.408 to 0.757; P<0.001). Significant differences in OS were observed in all subgroups except for the group of patients age≤60. Conclusions Pretreatment AAPR is an effective marker that predicts outcomes of patients with unresectable PDAC, potentially helping clinicians to identify patients at high risk and guide individualized treatment.

Prognostic Utility of Prechemoradiotherapy Albumin-to-Alkaline Phosphatase Ratio in Unresectable Locally Advanced Pancreatic Carcinoma Patients

“…Other notable discoveries of our study were the finding that lower pretreatment AAPR values were linked to significantly higher CA 19-9 levels and higher rates of N1-2 status and DM. These discoveries are in good accordance with the previously mentioned Zhang et al's investigation, which showed altogether higher proportions of CA 19-9 levels and stage IV disease status in the L-AAPR than the H-AAPR gathering [39], as well as the investigations at other tumor sites exhibiting significantly higher N+ status in the Abbreviations: CA 19-9: cancer antigen 19-9; N0-2; nodal stage 0-2; AAPR: albumin-to-alkaline phosphatase ratio; OS: overall survival; PFS: progression-free survival.…”

“…Therefore, it is challenging to discuss our results and solidly deduce them in the apparent absence of similar research. Nevertheless, the outcomes introduced here still seem to be accordant with the accessible AAPR studies in other tumor primaries [29][30][31][32][33][34][35][36][37][38] and two respective postoperative [44] and systemic chemotherapy [39] series in unresectable PACs. The first study by Pu et al [44] was a retrospective cohort analysis in 354 surgically resected PAC patients.…”

“…alone in terms of prediction of the postoperative clinical outcomes. More recently, Zhang et al [39] in a group of 419 unresectable PAC patients treated with systemic chemotherapy reported that the AAPR ≤ 0:4 (versus AAPR > 0:4) was associated with significantly inferior median OS durations (6.4 versus 9.3 months; P < 0:001), which appeared to be an independent predictor of unfavorable OS in multivariate analyses (HR: 0.0556; P < 0:001). However, our current research differs remarkably from Zhang et al's investigation in at least two critical manners.…”

“…Since past investigations exhibited that tumor-related detriments in the nutritional, antitumoral immune response and overall systemic inflammatory conditions were altogether correlated to tumor development and progression, the ALB-to-ALP ratio (AAPR) was postulated to be a reliable novel inflammation-based prognostic indicator in hepatocellular carcinoma in 2015 by Chan et al [29]. Following this hypothesis-generating study, the prognostic worth of AAPR was further tested and invariably confirmed in numerous other tumor primaries including renal cell carcinoma [30], cholangiocarcinoma [31], upper tract urothelial carcinoma [32], non-small-cell and small-cell lung carcinoma [33][34][35], nasopharyngeal carcinoma [36], cervical carcinoma [37], breast carcinoma [38], and pancreatic ductal carcinomas [39] and pancreatic neuroendocrine tumors [40].…”

“…Although the prognostic worth of AAPR has been investigated in unresectable PACs undergoing exclusive chemotherapy by Zhang et al [39], yet to our soundest information, the prognostic value of AAPR has never been examined in unresectable LAPACs treated with definitive CCRT before. In this manner, acknowledging the credible evidence in PACs, we aimed to retrospectively investigate the prognostic utility of pre-CCRT AAPR as a novel biomarker in unresectable LAPAC patients who received definitive CCRT.…”