Schuettfort Victor M, D Andrea David, Quhal Fahad, Mostafaei Hadi, Laukhtina Ekaterina, Mori Keiichiro, Sari Motlagh Reza, Rink Michael, Abufaraj Mohammad, Karakiewicz Pierre I, Luzzago Stefano, Rouprêt Morgan, Chlosta Piotr, Babjuk Marko, Deuker Marina, Moschini Marco, Shariat Shahrokh F, Pradere Benjamin
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Urol Oncol. 2021 Apr;39(4):235.e5-235.e14. doi: 10.1016/j.urolonc.2020.11.005. Epub 2020 Nov 11.
The Albumin-Globulin Ratio (AGR; albumin/total protein - albumin) has been associated with oncological outcome in various malignancies. However, its role in urothelial carcinoma of the bladder (UCB) has not been clearly established. In this study, we assessed the association of preoperative AGR (pAGR) with survival in patients who underwent radical cystectomy (RC) for UCB.
We conducted a retrospective analysis of an established multicenter database of 4.335 patients who were treated with RC for UCB. The cohort was divided into 2 groups according to the pAGR status. Binominal logistic regression as well as uni- and multivariable Cox regression analyses were used. The predictive value of the models was assessed by calculating receiver operating characteristics curves and concordance-indices (C-Index). The additional clinical value was assessed using the decision curve analysis (DCA).
Overall, 1.670 patients (38.5%) had a low pAGR. On multivariable logistic regression analyses, low pAGR was associated with an increased risk of ≥pT3 disease at RC (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.01-1.31, P= 0.04). On multivariable Cox regression analyses, low pAGR remained associated with worse recurrence-free survival (RFS, HR 1.24, 95% CI 1.1-1.37, P< 0.001), cancer-specific survival (CSS, HR 1.23, 95% CI 1.1-1.38, P< 0.001) and overall survival (OS, HR 1.17, 95% CI 1.07-1.28, P< 0.001). The addition of pAGR to multiple prognostic models that were respectively fitted for clinical and postoperative variables did not improve the predictive accuracy.
pAGR status is an independent predictor of ≥pT3 disease, therefore it could help identify patients who have a higher likelihood to benefit from neoadjuvant systemic therapy. While pAGR was independently associated with RFS, CSS, and OS, it did not improve the predictive accuracy and clinical value beyond obtained by information already available. The predictive value of this biomarker in the age of immunotherapy needs further evaluation.
白蛋白与球蛋白比值（AGR；白蛋白/总蛋白 - 白蛋白）已与多种恶性肿瘤的肿瘤学预后相关。然而，其在膀胱尿路上皮癌（UCB）中的作用尚未明确确立。在本研究中，我们评估了术前AGR（pAGR）与接受根治性膀胱切除术（RC）治疗UCB患者生存情况的相关性。
我们对一个已建立的包含4335例接受RC治疗UCB患者的多中心数据库进行了回顾性分析。根据pAGR状态将队列分为2组。采用二项逻辑回归以及单变量和多变量Cox回归分析。通过计算受试者工作特征曲线和一致性指数（C指数）评估模型的预测价值。使用决策曲线分析（DCA）评估额外的临床价值。
总体而言，1670例患者（38.5%）pAGR较低。在多变量逻辑回归分析中，低pAGR与RC时≥pT3疾病风险增加相关（比值比[OR] 1.15，95%置信区间[CI] 1.01 - 1.31，P = 0.04）。在多变量Cox回归分析中，低pAGR仍然与更差的无复发生存期（RFS，风险比[HR] 1.24，95% CI 1.1 - 1.37，P < 0.001）、癌症特异性生存期（CSS，HR 1.23，95% CI 1.1 - 1.38，P < 0.001）和总生存期（OS，HR 1.17，95% CI 1.07 - 1.28，P < 0.001）相关。将pAGR添加到分别针对临床和术后变量拟合的多个预后模型中并未提高预测准确性。
pAGR状态是≥pT3疾病的独立预测指标，因此它有助于识别更有可能从新辅助全身治疗中获益的患者。虽然pAGR与RFS、CSS和OS独立相关，但它并未提高预测准确性和超出已有信息所获得的临床价值。这种生物标志物在免疫治疗时代的预测价值需要进一步评估。
