The Prognostic Value of Albumin-to-Alkaline Phosphatase Ratio before Radical Radiotherapy in Patients with Non-metastatic Nasopharyngeal Carcinoma: A Propensity Score Matching Analysis

Abstract

PurposeWe first analyzed the prognostic power of albumin-to-alkaline phosphatase ratio (AAPR) before radical radiotherapy (RT) in non-metastatic nasopharyngeal carcinoma (NPC) patients.Materials and MethodsThe records of 170 patients with biopsy-proven, non-metastatic NPC treated by radical RT between 1998 and 2016 at our institution were retrospectively reviewed. Median follow-up duration was 50.6 months. All patients received intensity-modulated RT and cisplatin based chemotherapy before, during, or after RT. The major treatment of patients was based on concurrent chemoradiotherapy (92.4%). The AAPR was calculated by the last value of both albumin and alkaline phosphatase within 1 month immediately preceding RT. The optimal cut-off level of AAPR was determined by using Cutoff Finder, a web-based system. Propensity score matching (PSM) analysis was performed.ResultsThe optimal cut-off level of AAPR was 0.4876. After PSM analysis of whole cohort, an AAPR was not related to survival outcomes. In PSM analysis for patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC), an AAPR ≥ 0.4876 was related to better overall survival (OS), progression-free survival (PFS), and locoregional relapse–free survival (LRRFS) (OS: hazard ratio [HR], 0.341; 95% confidence interval [CI], 0.144 to 0.805; p=0.014; PFS: HR, 0.416; 95% CI, 0.189 to 0.914; p=0.029; and LRRFS: HR, 0.243; 95% CI, 0.077 to 0.769; p=0.016, respectively).ConclusionThe AAPR, inexpensive and readily derived from a routine blood test, could be an independent prognostic factor for patients with LA-NPC. And it might help physicians determine treatment plans by identifying the patient's current status. Future prospective clinical trials to validate its prognostic value are needed.

Predictive value of pretreatment albumin‐to‐alkaline phosphatase ratio for overall survival for patients with advanced non‐small cell lung cancer

“…13,14 Since Chan et al 15 firstly reported the ratio of ALB to ALP combined with ALB and ALP levels can be used as an indicator for predicting the prognosis for patients with liver cancer, and such prediction ability is higher than that based on ALB or ALP levels alone, more studies began to investigate these indicators in other types of cancer. [7][8][9][10][16][17][18][19][20][21] Li et al 16 firstly reported that the relationship between AAPR and OS after investigating 290 stage IV NSCLC patients, finding that AAPR was an independent predictor of OS in multivariate analysis (HR = 0.657, 95% CI = 0.504-0.856, P < .01). Different from their study, we conducted a larger respective cohort as well as included more important variables for analysis, such EGFR and ALK mutation status, ECOG-performance status, therapeutic regiment, F I G U R E 4 Forest plot for presenting the association between the hazard ratio of overall survival and medium AAPR in advanced NSCLC patients and organ metastasis parameters, which have been verified to exert influence on the clinical outcome of the NSCLC patients.…”

“…It is now well-established from a variety of studies, that AAPR has been examined in several cancer types showing some promising results. [7][8][9][10] However, few researchers have addressed the relationship between AAPR and OS in patients with advanced NSCLC. Therefore, in this work, we conducted a retrospective study with a large cohort of patients aiming to analyze the prognostic power of AAPR in advanced NSCLC.…”

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

“…Although we got relatively certain conclusions according to the pooled results, we consider that there are still many elds about the prognostic value of pretreatment AAPR deserving more investigation. With the exception of the study conducted by Kim et al [21], all the other studies are from China. Therefore, the predictive role of pretreatment AAPR for survival of cancer patients in other countries or regions needs to be further clari ed.…”

“…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.…”

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

“…11 Subsequently, it has been reported as a novel prognostic factor in different malignant carcinomas, including nasopharyngeal carcinoma, pancreatic ductal adenocarcinoma, breast cancer, lung cancer, and cholangiocarcinoma. [12][13][14][15][16][17] However, the pretreatment level of AAPR and their prognostic role in cervical cancer have not ever been evaluated. Hence, we retrospectively studied the prognostic significance of AAPR in cervical cancer patients with stage IB-IIA disease, followed by the correlation of AAPR with other clinicopathological features.…”