Prognostic role of pretreatment albumin-to-alkaline phosphatase ratio in locally advanced laryngeal and hypopharyngeal cancer: Retrospective cohort study

Abstract

Background: This study was designed to assess the prognostic significance of pretreatment albumin-toalkaline phosphatase ratio (AAPR) in locally advanced laryngeal and hypopharyngeal cancer (LA-LHC). Materials and Methods:The clinical data of 341 patients with locally advanced laryngeal and hypopharyngeal cancer diagnosed between March 2007 and December 2018 were retrospectively collected and analyzed. The optimal cut-off value of AAPR for evaluating DFS was determined using the ROC curve, and 0.4912 was selected. Based on pretreatment AAPR values, patients were divided into two groups (low vs. high AAPR). Survival analysis was used to investigate the survival distribution between the groups. Univariate and multivariate analyses were performed to evaluate the prognostic value of AAPR. Based on the results of the multivariate analysis, we further developed models of DFS and OS. We assigned low AAPR, N1-3, age ≥65 years, and positive vascular invasion one score, respectively. Results: Survival analysis demonstrated that the survival of patients with low and high AAPR was significantly different (low vs. high AAPR: 5-year DFS, 46.0 vs. 71.9%, p<0.001; 5-year OS, 69.0 vs. 72.6%, p<0.001). Univariate and multivariate analyses further showed that pretreatment AAPR served as an independent indicator in LA-LHC. Moreover, survival analysis showed that patients with high model score had poorer DFS and OS (5-year DFS: 58.1, 42.7, 26.9 and 9.1% of score zero, one, two, and three respectively, p<0.001; 5-year OS: 63.0, 50.3, 34.1 and 28.6% of score zero, one, two, and three respectively, p<0.001). Conclusion: Pretreatment AAPR could be an independent prognostic indicator in patients with LA-LHC. Incorporating AAPR into the risk stratification model might better categorize patients with worse oncological outcomes and support treatment strategy making.

The Prognostic Value of Preoperative Albumin-to-Alkaline Phosphatase Ratio on Survival Outcome for Patients With Locally Advanced Oral Squamous Cell Carcinoma

“… 31 Another study also echoed that higher preoperative AAPR was one of the favorable predictors of DFS and OS in patients with locally advanced laryngeal and hypopharyngeal cancer. 10 Our study further strengthens the survival predictability of preoperative AAPR in the clinical practice for patients with LAOSCC.…”

“…28 Another study for patients with advanced NSCLC observed that an AAPR cut-off point of 0.36 was suitable for predicting OS. 29 For head and neck cancer, the optimal cut-off value is 0.51 for patients with LAOSCC as shown in our cohort, 0.4912 in the study for locally advanced laryngeal and hypopharyngeal cancer, 10 and 0.4876 for locally advanced NPC and 0.447 for metastatic NPC, respectively. 30,31 Generally, the optimal cut-off values can be determined by several statistical methods.…”

“… 5 For head and neck cancers, serum albumin and its associated biomarkers, such as prognostic nutrition index, and albumin-to-globulin ratio, have also been observed as predictors of survival and perioperative outcomes. 6 – 10 …”

“…5 For head and neck cancers, serum albumin and its associated biomarkers, such as prognostic nutrition index, and albumin-toglobulin ratio, have also been observed as predictors of survival and perioperative outcomes. [6][7][8][9][10] Alkaline phosphatase (ALP) is enriched in the kidney, bile duct, and liver and the elevation of ALP was also reported to be found in diverse malignancies and correlated to poor outcomes. 11,12 Albumin-to-alkaline phosphatase ratio (AAPR) was firstly investigated to be a novel prognosticator in hepatocellular carcinoma in 2015 and a series of studies have shown the clinical significance of prognosis in several malignancies.…”

Non-linear Association of Alkaline Phosphatase-to-Albumin Ratio with All-Cause and Cancer Mortality: Evidence from NHANES 2005-2016

“…Additionally, a study conducted by Liu et al demonstrated that APAR was independently associated with mortality in patients with sepsis [14]. Moreover, higher APAR levels were independently associated to increased cancer mortality as reported, including lung cancer [7,8,11], hepatocellular carcinoma [6], pancreatic ductal adenocarcinoma [9,20], nasopharyngeal carcinoma [12], urothelial carcinoma [13], and some other types [22][23][24][25][26][27][28][29]. However, there is limited evidence from large-scale general populations, making direct comparisons with our study challenging due to the heterogeneity of the study populations.…”