Deng Yan, Pang Qing, Miao Run-Chen, Chen Wei, Zhou Yan-Yan, Bi Jian-Bin, Liu Su-Shun, Zhang Jing-Yao, Qu Kai, Liu Chang
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China.
Onco Targets Ther. 2016 Aug 24;9:5317-28. doi: 10.2147/OTT.S109736. eCollection 2016.
Pretreatment nutritional and immunological statuses play an indispensable role in predicting the outcome of patients with various types of malignancies. The purpose of this study is to evaluate the predictive value of albumin/globulin ratio (AGR) in overall survival (OS) and recurrence in patients with hepatocellular carcinoma (HCC) following radical hepatic carcinectomy.
This retrospective study included a total of 172 patients with HCC with complete medical and follow-up information between 2002 and 2012. AGR was calculated according to the following formula: AGR = albumin/globulin. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff value. The associations of AGR with clinicopathological characteristics and prognosis were assessed. Further multivariate analysis using Cox regression model and subgroup analysis was performed to evaluate the predictive value.
Receiver operating characteristic curve determined 37.65, 31.99, and 1.48 as the optimal cutoff values of albumin, globulin, and AGR in terms of 5-year OS or death, respectively. On the basis of the cutoff value of AGR, all the patients were divided, respectively, into low-AGR (n=105) and high-AGR (n=67) groups. AGR was found to be significantly correlated with age, cancer embolus, international normalized ratio, and postoperative outcome (P<0.05). Hepatitis B virus infection (hazard ratio [HR]: 2.125; 95% confidence interval [CI]: 1.285-3.153), tumor node metastasis stage (HR: 1.656; 95% CI: 1.234-2.223), serum albumin (HR: 0.546; 95% CI: 0.347-0.857), and AGR (HR: 0.402; 95% CI: 0.233-0.691) were independent predictors of OS via univariate and multivariate survival analyses. However, alpha-fetoprotein (HR: 1.708; 95% CI: 1.027-2.838), tumor node metastasis stage (HR: 1.464; 95% CI: 1.078-1.989), and AGR (HR: 0.493; 95% CI: 0.293-0.828) functioned as independent risk variables for predicting recurrence. Moreover, AGR showed superior prognostic value for OS and recurrence in the subgroups with normal level of albumin or survival time beyond 6 months.
Pretreatment AGR might serve as an effective biomarker to evaluate the prognosis of patients with a diagnosis of HCC. Based on the results, AGR, characterized with easy accessibility, objectivity, and noninvasiveness, should be included in the routine assessment of HCC.
治疗前的营养和免疫状态在预测各类恶性肿瘤患者的预后方面发挥着不可或缺的作用。本研究旨在评估白蛋白/球蛋白比值（AGR）对肝细胞癌（HCC）患者根治性肝切除术后总生存期（OS）和复发的预测价值。
这项回顾性研究纳入了2002年至2012年间共有172例具有完整医疗和随访信息的HCC患者。AGR根据以下公式计算：AGR = 白蛋白/球蛋白。进行受试者工作特征曲线分析以确定最佳临界值。评估AGR与临床病理特征及预后的相关性。使用Cox回归模型进行进一步的多因素分析和亚组分析以评估预测价值。
受试者工作特征曲线确定白蛋白、球蛋白和AGR在5年总生存期或死亡方面的最佳临界值分别为37.65、31.99和1.48。根据AGR的临界值将所有患者分别分为低AGR组（n = 105）和高AGR组（n = 67）。发现AGR与年龄、癌栓、国际标准化比值及术后结果显著相关（P<0.05）。通过单因素和多因素生存分析，乙型肝炎病毒感染（风险比[HR]：2.125；95%置信区间[CI]：1.285 - 3.153）、肿瘤淋巴结转移分期（HR：1.656；95% CI：1.234 - 2.223）、血清白蛋白（HR：0.546；95% CI：0.347 - 0.857）和AGR（HR：（0.402；95% CI：0.233 - 0.691）是总生存期的独立预测因子。然而，甲胎蛋白（HR：1.708；95% CI：1.027 - 2.838）、肿瘤淋巴结转移分期（HR：1.464；95% CI：1.078 - 1.989）和AGR（HR：0.493；95% CI：0.293 - 0.828）是预测复发的独立风险变量。此外，AGR在白蛋白水平正常或生存时间超过6个月的亚组中对总生存期和复发显示出更好的预后价值。
治疗前AGR可能作为评估HCC诊断患者预后的有效生物标志物。基于这些结果，AGR具有易于获取、客观和无创的特点，应纳入HCC的常规评估中。
