The prognostic significance of Albumin-to-Alkaline Phosphatase Ratio in upper tract urothelial carcinoma

Abstract

To assess the prognostic impact of pretreatment albumin-to-alkaline phosphatase ratio (AAPR) in patients with upper tract urothelial carcinoma (UTUC), the data of 692 patients, operated between 2003 and 2016 in our center, were retrospectively assessed. The threshold of AAPR was defined as 0.58 by using the receiver-operating curve analysis. Overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were evaluated using the Kaplan-Meier method. And the univariate and multivariate Cox’s regression models were performed to identify independent prognostic predictors. The results showed that AAPR <0.58 was significantly related to higher pT stage and grade, concomitant variant histology, anemia and larger tumor size. Additionally, patients with a lower AAPR had an inferior survival outcomes than those with an AAPR ≥0.58 (all P < 0.001). Multivariate analysis suggested that the lower AAPR was also an independent risk factor for poor OS (HR 1.587, 95%CI: 1.185–2.126; P = 0.002), CSS (HR 1.746, 95%CI: 1.249–2.440; P = 0.001), and RFS (HR 1.337, 95%CI: 1.027–1.739; P = 0.031). Moreover, subgroup analysis demonstrated the lower AAPR was related to worse prognosis in high-grade UTUC patients; but in those with low-grade disease, no relationship between them was observed. In conclusion, our results found that the decreased AAPR was independently related to poor survival outcomes in UTUC patients. Using the AAPR for subclassification of high-grade UTUC seems to further identify a poor prognostic group and contribute to clinical decisions making.

The prognostic value of the preoperative albumin to alkaline phosphatase ratio in patients with non‐small cell lung cancer after surgery

“…first reported the prognostic value of the AAPR and revealed that the AAPR was a significant prognostic predictor in hepatocellular carcinoma (HCC) . Similar studies have been subsequently reported in other types of cancers, including small cell lung cancer (SCLC) . However, the prognostic value of the AAPR has not yet been well studied in non‐small cell lung cancer (NSCLC) patients.…”

“…the AAPR was found to be an independent prognostic factor for OS and DFS in patients with HCC regardless of the treatment approach . Since then, the AAPR has been proven to be a significant prognostic predictor for nasopharyngeal carcinoma, SCLC, and upper tract urothelial carcinoma (UTUC), whereas it has not yet been explored in patients with NSCLC …”

<p>The Prognostic Significance Of Pretreatment Albumin/alkaline Phosphatase Ratio In Patients With Stage IB-IIA Cervical Cancer</p>

“…Our results showed that the low AAPR contributed to worse survival outcomes in well and moderate differentiated cervical cancer; but in terms of poorly differentiated disease, there was no significant relationship between them, which was consistent with the result obtained in upper tract urothelial carcinoma. 39 The result gave us a prompt that patients with low AAPR level should have their cancer status and physical condition evaluated more carefully compared with the high-AAPR group, especially in well and moderate differentiated patients. In our study, adjuvant therapy was found to be an independent prognostic index for OS and DFS.…”

“…36 Prior studies have shown that nutrient deficiency and systematic inflammatory response might play a critical role in the pathogenesis and progression of human carcinomas and were correlated with inferior prognosis in patients undergoing resection for solid tumors. 8,[37][38][39] Zheng et al have demonstrated that ALB is an independent prognostic indicator in early operable cervical cancer. 40 Moreover, a recent published article found that high levels of ALP could influence tumorigenesis and predict outcomes in cervical cancer patients.…”

Prognostic Significance of Pretreatment Albumin to Alkaline Phosphatase Ratio in Human Cancers: A Meta-Analysis

“…The characteristics of the included studies were shown in Table 1. In the current research, 15 retrospective articles with 6,062 cancer patients were included [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. Because of the subgroup analysis in three articles [15,17,19], we regarded them as 2 or 3 independent studies.…”