Zhao Hong, Li Xiangrui, Liu Xiaoyue, Liu Chenan, Zheng Xin, Chen Yue, Shi Jinyu, Liu Qiteng, Bu Zhaoting, Shi Hanping
Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China.
BMC Cancer. 2025 Jan 29;25(1):168. doi: 10.1186/s12885-025-13480-x.
The albumin-to-creatinine ratio (ACR) is known to predict prognosis in liposarcoma patients, but its role in other tumors remains unclear. This study aimed to evaluate the prognostic relationship between ACR and common solid tumors.
Data from the Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) between 2013 and 2022 were used to analyze patients under 65 years old with solid tumors. Patients were divided into a training cohort (n = 12,027) and a validation cohort (n = 7,985) using simple random sampling. Correlation analysis, Kaplan-Meier method, and restricted cubic spline analysis were conducted to explore ACR's relationship with overall survival (OS). Multivariable logistic regression assessed associations between ACR and Patient-Generated Subjective Global Assessment (PG-SGA), Length of Stay (LOS), and Karnofsky Performance Status (KPS).
In Cox regression, higher ACR levels were associated with better OS in solid tumor patients. Specifically, when using the cutoff value with low ACR as the reference, higher ACR levels were significantly associated with improved OS. For nasopharyngeal carcinoma (HR = 0.49, 95% CI: 0.35-0.67, P < 0.001), gastrointestinal tract tumors (HR = 0.84, 95% CI: 0.74-0.95, P = 0.007), and urogenital neoplasms (HR = 0.55, 95% CI: 0.43-0.71, P < 0.001), higher ACR levels were linked to better OS. When ACR was categorized into tertiles, the results were consistent with those observed using the cutoff value. In gastrointestinal tract tumor patients, higher ACR levels were linked to lower PG-SGA scores and improved KPS scores (P < 0.05). In urogenital neoplasm patients, higher ACR levels were associated with improved KPS scores (P < 0.05).
Elevated ACR levels were significantly associated with improved OS in cancer patients, particularly in nasopharyngeal carcinoma, gastrointestinal tract tumors, and urogenital neoplasms. ACR was also linked to better nutritional and functional status, suggesting its potential as a prognostic biomarker.
已知白蛋白与肌酐比值（ACR）可预测脂肪肉瘤患者的预后，但其在其他肿瘤中的作用尚不清楚。本研究旨在评估ACR与常见实体瘤之间的预后关系。
使用2013年至2022年常见癌症营养状况与临床结局调查（INSCOC）的数据，分析65岁以下的实体瘤患者。采用简单随机抽样将患者分为训练队列（n = 12,027）和验证队列（n = 7,985）。进行相关性分析、Kaplan-Meier法和受限立方样条分析，以探讨ACR与总生存期（OS）的关系。多变量逻辑回归评估ACR与患者主观整体评估（PG-SGA）、住院时间（LOS）和卡诺夫斯基功能状态（KPS）之间的关联。
在Cox回归中，实体瘤患者中较高的ACR水平与较好的OS相关。具体而言，以低ACR的临界值作为参照时，较高的ACR水平与OS改善显著相关。对于鼻咽癌（HR = 0.49，95%CI：0.35 - 0.67，P < 0.001）、胃肠道肿瘤（HR = 0.84，95%CI：0.74 - 0.95，P = 0.007）和泌尿生殖系统肿瘤（HR = 0.55，95%CI：0.43 - 0.71，P < 0.001），较高的ACR水平与较好的OS相关。当将ACR分为三分位数时，结果与使用临界值时观察到的结果一致。在胃肠道肿瘤患者中，较高的ACR水平与较低的PG-SGA评分和改善的KPS评分相关（P < 0.05）。在泌尿生殖系统肿瘤患者中，较高的ACR水平与改善的KPS评分相关（P < 0.05）。
ACR水平升高与癌症患者，尤其是鼻咽癌、胃肠道肿瘤和泌尿生殖系统肿瘤患者的OS改善显著相关。ACR还与更好的营养和功能状态相关，表明其作为预后生物标志物的潜力。
