Department of Urology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Department of ADPKD Research, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
BMC Urol. 2020 Aug 28;20(1):133. doi: 10.1186/s12894-020-00700-8.
Although the albumin-to-globulin ratio (AGR) is a promising biomarker for various malignancies, few studies have investigated its prognostic significance for upper tract urothelial carcinoma (UTUC).
This retrospective study conformed to the REporting recommendations for tumour MARKer prognostic studies (REMARK) guideline. We reviewed 179 patients with UTUC who underwent radical nephroureterectomy at our institution between 2008 and 2018. Associations of preoperative clinicopathological factors, including the AGR, with cancer-specific survival (CSS) and overall survival (OS) were assessed. The Cox proportional hazards model was used for univariate and multivariable analyses. AGR was dichotomized as < 1.25 and ≥ 1.25, according to the most discriminatory cutoff determined from the receiver operating characteristic curve analysis.
During a median follow-up of 34 months after surgery, 37 patients died from UTUC and 13 died of other causes. The preoperative AGR significantly correlated with pathological T stage, pathological N stage, and adjuvant chemotherapy. Multivariate analyses demonstrated that a decreased (< 1.25) preoperative AGR was an independent poor prognostic factor for both CSS (hazard ratio [HR] = 2.81, P < 0.01) and OS (HR = 2.09, P < 0.05).
Preoperative AGR < 1.25 might serve as a useful prognostic marker for patients with UTUC undergoing radical nephroureterectomy.
尽管白蛋白/球蛋白比值（AGR）是多种恶性肿瘤有前途的生物标志物，但很少有研究调查其对上尿路上皮癌（UTUC）的预后意义。
本回顾性研究符合肿瘤标志物预后研究报告建议（REMARK）指南。我们回顾了 2008 年至 2018 年期间在我们机构接受根治性肾输尿管切除术的 179 例 UTUC 患者。评估了术前临床病理因素（包括 AGR）与癌症特异性生存（CSS）和总生存（OS）的相关性。使用 Cox 比例风险模型进行单变量和多变量分析。根据接受者操作特征曲线分析确定的最具区分力的截断值，将 AGR 分为<1.25 和≥1.25。
在手术后中位数为 34 个月的随访期间，37 例患者死于 UTUC，13 例患者死于其他原因。术前 AGR 与病理 T 分期、病理 N 分期和辅助化疗显著相关。多变量分析表明，术前 AGR 降低（<1.25）是 CSS（风险比 [HR] =2.81，P<0.01）和 OS（HR =2.09，P<0.05）的独立不良预后因素。
术前 AGR<1.25 可能是接受根治性肾输尿管切除术的 UTUC 患者的有用预后标志物。
