Laukhtina Ekaterina, Pradere Benjamin, D'Andrea David, Rosiello Giuseppe, Luzzago Stefano, Pecoraro Angela, Palumbo Carlotta, Knipper Sophie, Karakiewicz Pierre I, Margulis Vitaly, Quhal Fahad, Motlagh Reza Sari, Mostafaei Hadi, Mori Keiichiro, Schuettfort Victor M, Enikeev Dmitry, Shariat Shahrokh F
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
Transl Androl Urol. 2021 Feb;10(2):609-619. doi: 10.21037/tau-20-1101.
Accurate identification of ideal candidates for cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) is an unmet need. We tested the association between preoperative value of systemic albumin to globulin ratio (AGR) and overall survival (OS) as well as cancer-specific survival (CSS) in mRCC patients treated with CN.
mRCC patients treated with CN were included. The overall population was therefore divided into two AGR groups using cut-off of 1.43 (low, <1.43 high, ≥1.43). Univariable and multivariable Cox regression analyses tested the association between AGR and OS as well as CSS. The discrimination of the model was evaluated with the Harrel's concordance index (C-index). The clinical value of the AGR was evaluated with decision curve analysis (DCA).
Among 613 mRCC patients, 159 (26%) patients had an AGR <1.43. Median follow-up was 31 (IQR: 16-58) months. On univariable analysis, low preoperative serum AGR was significantly associated with both OS (HR: 1.55, 95% CI: 1.26-1.89, P<0.001) and CSS (HR: 1.55, 95% CI: 1.27-1.90, P<0.001). On multivariable analysis, AGR <1.43 was associated with worse OS (HR: 1.51, 95% CI: 1.23-1.85, P<0.001) and CSS (HR: 1.52, 95% CI: 1.24-1.86, P<0.001). The addition of AGR only minimally improved the discrimination of a base model that included established clinicopathologic features (C-index=0.640 C-index=0.629). On DCA, the inclusion of AGR marginally improved the net benefit of the prognostic model. Low AGR remained independently associated with OS and CSS in the IMDC intermediate risk group (HR: 1.52, 95% CI: 1.16-1.99, P=0.002).
In our study, low AGR before CN was associated with worse OS and CSS, particularly in intermediate risk patients.
准确识别转移性肾细胞癌（mRCC）减瘤性肾切除术（CN）的理想候选者是一项尚未满足的需求。我们测试了术前血清白蛋白与球蛋白比值（AGR）值与接受CN治疗的mRCC患者的总生存期（OS）以及癌症特异性生存期（CSS）之间的关联。
纳入接受CN治疗的mRCC患者。因此，根据AGR值1.43将总体人群分为两组（低AGR组，<1.43；高AGR组，≥1.43）。单变量和多变量Cox回归分析测试了AGR与OS以及CSS之间的关联。用Harrel一致性指数（C指数）评估模型的辨别力。用决策曲线分析（DCA）评估AGR的临床价值。
在613例mRCC患者中，159例（26%）患者的AGR<1.43。中位随访时间为31（四分位间距：16 - 58）个月。单变量分析显示，术前血清AGR低与OS（风险比：1.55，95%置信区间：1.26 - 1.89，P<0.001）和CSS（风险比：1.55，95%置信区间：1.27 - 1.90，P<0.001）均显著相关。多变量分析显示，AGR<1.43与较差的OS（风险比：1.51，95%置信区间：1.23 - 1.85，P<0.001）和CSS（风险比：1.52，95%置信区间：1.24 - 1.86，P<0.001）相关。仅加入AGR对包含既定临床病理特征的基础模型的辨别力改善甚微（C指数=0.640对C指数=0.629）。在DCA中，加入AGR对预后模型的净效益有轻微改善。在国际转移性肾细胞癌数据库（IMDC）中危风险组，低AGR仍与OS和CSS独立相关（风险比：1.52，95%置信区间：1.16 - 1.99，P = 0.002）。
在我们的研究中，CN术前AGR低与较差的OS和CSS相关，尤其是在中危风险患者中。
