Albumin to alkaline phosphatase ratio: does it predict survival in grade 1 and grade 2 neuroendocrine tumors?

Abstract

BACKGROUND: Neuroendocrine tumors (NETs) are very heterogeneous tumors. Although it is classified according to Ki-67 proliferation index and mitotic count, their behavior may greatly vary even in the same group. Therefore, more accurate prognostic markers are required to predict prognosis in patients with well differentiated NETs. This study is aimed to evaluate prognostic value of albumin to alkaline phosphatase ratio (AAPR) in patients with well differentiated neuroendocrine tumors. PATIENTS AND METHODS: A total of 110 patients included in this study. Patients' data were obtained from registration data-base of the hospital and reviewed retrospectively. AAPR was calculated by dividing albumin concentration (g/dl) to alkaline phosphatase level (U/L). Cut off value for AAPR was determined by Receiver Operating Characteristic (ROC) analysis. Survival analysis was performed by Kaplan-Meier method with the Long-rank test. We reported two-sided p value and p<0.05 was considered statistically significant.RESULT: The calculated optimum cut-off value for AAPR was 0.028. Patients were divided into two groups as patients with AAPR ≤0.028 (n:22, 20%) and, with AAPR >0.028 (n:88, 80%). Patients with AAPR >0.028 had statistically longer overall survival (OS) compared with patients with ≤0.028 ( NR vs 96,8 months, p=0.001). Additionally, AAPR has been shown to be an independent prognostic factor for OS in in multivariate analysis (HR=4.942, 95% CI=1.693-14.420, p=0.003).CONCLUSION: Patients with higher AAPR had more favourable prognosis compared to patients with lower AAPR. We demonstrated that AAPR can be of prognostic value in well-differentiated NETs.

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).…”

“…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). However, to our knowledge, the potential prognostic value of AAPR has not yet been explored in patients undergoing esophagectomy for EC.…”

Albumin-to-Alkaline Phosphatase Ratio as a Prognostic Biomarker for Spinal Fusion in Lumbar Degenerative Diseases Patients Undergoing Lumbar Spinal Fusion

“…AAPR was applied in patients undergoing surgery for hepatocellular carcinoma for the first time by Chan et al; this conclusion has been confirmed in the following studies [ 35 , 36 ]. Furthermore, previous research has shown that low levels of this indicator are associated with poor outcomes [ 37 , 38 ]. Despite varying cutoff values, these studies confirm that patients with high AAPR have a better prognosis than those with low AAPR.…”

Development and validation of a nomogram prediction model based on albumin-to-alkaline phosphatase ratio for predicting the prognosis of gallbladder carcinoma

“…AAPR is the ratio of ALB to ALP. Several studies have demonstrated that low AAPR is strongly associated with poor prognosis in malignancies [6,[30][31][32][33].…”