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Decreased Albumin-to-Globulin Ratio (AGR) and Its Prognostic Significance in Cancer
Introduction to Albumin-to-Globulin Ratio (AGR)
The albumin-to-globulin ratio (AGR) is a simple blood test that measures the relative amounts of albumin and globulin in the blood. A decreased AGR has been increasingly recognized as a significant prognostic marker in various types of cancers. This article synthesizes findings from multiple studies to elucidate the prognostic implications of a low AGR in cancer patients.
AGR as a Prognostic Marker in Urothelial Carcinoma
A comprehensive pooled analysis involving 9,002 patients with urothelial carcinoma (UC) revealed that a low preoperative AGR is significantly associated with poorer overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), progression-free survival (PFS), and metastasis-free survival (MFS) following radical surgery 1. Specifically, the hazard ratios (HRs) for OS, CSS, RFS, PFS, and MFS were 1.85, 2.38, 1.64, 2.16, and 3.00, respectively, indicating a strong correlation between low AGR and adverse outcomes in UC patients.
AGR in Patients Treated with Immune Checkpoint Inhibitors
In a cohort study of 212 advanced-stage cancer patients treated with immune checkpoint inhibitors (ICIs), a lower AGR (<1.21) was associated with decreased OS and PFS. The HRs for OS and PFS were 1.530 and 1.390, respectively, suggesting that AGR can be a useful biomarker for predicting survival outcomes in ICI-treated patients 3.
Meta-Analyses on AGR in Various Cancers
General Cancer Prognosis
A meta-analysis encompassing 28 studies with 15,356 cancer patients demonstrated that a low pretreatment AGR is linked to poor OS, DFS, and PFS across various cancer types. The HRs for OS, DFS, and PFS were 2.08, 1.96, and 1.89, respectively, underscoring the broad applicability of AGR as a prognostic marker in cancer therapy 4.
Digestive System Cancers
In digestive system cancers (DSCs), a meta-analysis of 13 studies involving 9,269 patients found that a low AGR was significantly correlated with poor OS and DFS. The HRs for OS and DFS were 1.94 and 1.49, respectively, indicating that AGR is a valuable prognostic indicator in DSCs 5.
Head and Neck Cancer
A systematic review and meta-analysis of nine studies with 3,211 head and neck cancer (HNC) patients revealed that a low pretreatment AGR is associated with poor disease-free survival (HR = 1.97), distant metastasis-free survival (HR = 1.64), and overall survival (HR = 2.18). These findings suggest that AGR can serve as a prognostic biomarker in HNC management 6.
Gastric Cancer
In gastric cancer (GC), a meta-analysis of 12 studies with 8,305 patients indicated that a low AGR is closely associated with worse OS (HR = 1.531) and DFS/PFS (HR = 2.008). This highlights the potential of AGR as an efficient prognostic indicator for GC 7.
Colorectal Cancer
A meta-analysis of 11 studies involving 8,397 colorectal cancer (CRC) patients demonstrated that a low AGR is significantly associated with poor OS (HR = 2.58) and DFS/PFS (HR = 2.11). However, AGR was not a significant prognostic factor for cancer-specific survival (CSS) in CRC 9.
Conclusion
The albumin-to-globulin ratio (AGR) is a valuable prognostic marker across various cancer types. A decreased AGR is consistently associated with poorer survival outcomes, including overall survival, disease-free survival, and progression-free survival. These findings underscore the importance of incorporating AGR into routine clinical assessments to better predict patient prognosis and tailor treatment strategies accordingly.
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Most relevant research papers on this topic
Decreased Preoperative Serum AGR as a Diagnostic Marker of Poor Prognosis after Radical Surgery of Upper Urinary Tract and Bladder Cancers from a Pooled Analysis of 9,002 Patients
Preoperative low AGR levels are a risk factor for urothelial carcinoma and can predict poor prognosis after radical surgery for upper urinary tract and bladder cancers.
Meta-Analysis
Rigorous JournalImpact of influent COD/N ratio on disintegration of aerobic granular sludge.
Decreased COD/N ratios in wastewater can lead to disintegration of aerobic granular sludge, affecting its physical properties and nitrification efficiency, while flocculent sludge remains stable.
Highly CitedThe association between albumin-globulin ratio (AGR) and survival in patients treated with immune checkpoint inhibitors.
Lower albumin-globulin ratio (AGR) is associated with decreased survival and progression-free survival in patients treated with immune checkpoint inhibitors, and can predict early progression and long-term benefit.
Observational StudyPretreatment albumin to globulin ratio can serve as a prognostic marker in human cancers: a meta-analysis.
Low pretreatment albumin to globulin ratio is associated with poor prognosis in human cancers, and should be used as a prognostic marker during cancer therapy.
Meta-AnalysisHighly CitedPrognostic value of pretreatment albumin/globulin ratio in digestive system cancers: A meta-analysis
A low pretreatment albumin/globulin ratio is associated with unfavorable survival in digestive system cancers, suggesting it may be a useful predictive biomarker.
Meta-AnalysisRigorous JournalLow Pretreatment Albumin-to-Globulin Ratios Predict Poor Survival Outcomes in Patients with Head and Neck Cancer: A Systematic Review and Meta-analysis
Low pretreatment albumin-to-globulin ratios are strongly associated with poor survival outcomes and advanced cancer status in patients with head and neck cancer.
Meta-AnalysisLow Pretreatment Albumin-to-Globulin Ratio Predicts Poor Prognosis in Gastric Cancer: Insight From a Meta-Analysis
Low pretreatment albumin-to-globulin ratio predicts poor prognosis in gastric cancer patients, acting as an efficient prognostic indicator.
Meta-AnalysisClinical burden of preoperative albumin-globulin ratio in esophageal cancer patients.
Lower albumin-globulin ratio is a significant predictor of overall survival and disease-free survival in esophageal cancer patients, and may help identify candidates for more intensive adjuvant therapy.
Observational StudyPrognostic Value of the Albumin-to-Globulin Ratio in Patients with Colorectal Cancer: A Meta-Analysis
A low albumin-to-globulin ratio is significantly associated with worse overall survival and inferior disease-free survival/progression-free survival in colorectal cancer patients.
Meta-Analysis