Huang Xiaoming, Li Lingjuan, Zang Di
Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
National Center for Neurological Disorders, Shanghai, China.
Front Pharmacol. 2025 Jul 16;16:1556108. doi: 10.3389/fphar.2025.1556108. eCollection 2025.
The albumin-to-alkaline phosphatase ratio (AAPR) has recently emerged as a novel prognostic biomarker in various solid tumors. However, its clinical value in lower-grade glioma (LGG) remains unclear.
We performed propensity score matching (PSM) to balance baseline characteristics between groups. Restricted cubic spline (RCS) analysis was used to evaluate the nonlinear relationship between AAPR and survival outcomes. Survival differences were assessed using Kaplan-Meier analysis, and both univariate and multivariate Cox regression models were applied to identify independent prognostic factors. Finally, a predictive nomogram was developed to estimate 1-, 3-, and 5-year overall survival.
RCS analysis revealed a nonlinear relationship between AAPR and OS (p = 0.0349). Patients were stratified by the median AAPR value (0.704), and those in the AAPR-High group (≥0.704) had significantly better OS (log-rank p = 0.0042) and progression-free survival (PFS) (log-rank p = 0.042) than those in the AAPR-Low group. AAPR showed stronger prognostic value in low-risk subgroups. Higher AAPR was significantly associated with better OS in univariate (p = 0.005, HR = 0.541, 95% CI: 0.353-0.829) and multivariate Cox analyses (p = 0.046, HR = 0.630, 95% CI: 0.400-0.993). The AAPR-based nomogram demonstrated good predictive performance for 1-, 3-, and 5-year OS, validated in the PSM cohort.
Pre-treatment AAPR is a simple, non-invasive, and effective biomarker for predicting prognosis in LGG patients, particularly those at lower clinical risk.
白蛋白与碱性磷酸酶比值（AAPR）最近已成为各种实体瘤中的一种新型预后生物标志物。然而，其在低级别胶质瘤（LGG）中的临床价值仍不清楚。
我们进行倾向评分匹配（PSM）以平衡组间基线特征。使用限制立方样条（RCS）分析来评估AAPR与生存结果之间的非线性关系。使用Kaplan-Meier分析评估生存差异，并应用单变量和多变量Cox回归模型来识别独立的预后因素。最后，开发了一种预测列线图以估计1年、3年和5年总生存率。
RCS分析显示AAPR与总生存期（OS）之间存在非线性关系（p = 0.0349）。患者按AAPR中位数（0.704）分层，AAPR高组（≥0.704）患者的OS（对数秩p = 0.0042）和无进展生存期（PFS）（对数秩p = 0.042）明显优于AAPR低组。AAPR在低风险亚组中显示出更强的预后价值。在单变量（p = 0.005，HR = 0.541，95%CI：0.353 - 0.829）和多变量Cox分析（p = 0.046，HR = 0.630，95%CI：0.400 - 0.993）中，较高的AAPR与更好的OS显著相关。基于AAPR的列线图在PSM队列中得到验证，对1年、3年和5年OS具有良好的预测性能。
治疗前AAPR是一种简单、无创且有效的生物标志物，可用于预测LGG患者的预后，尤其是临床风险较低的患者。
