Low albumin to globulin ratio
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Low Albumin to Globulin Ratio: Prognostic Implications in Cancer
Introduction to Albumin to Globulin Ratio (AGR)
The albumin to globulin ratio (AGR) is a simple blood test that measures the balance between albumin and globulin proteins in the blood. This ratio has been increasingly recognized as a potential prognostic marker in various cancers. A low AGR has been associated with poor outcomes in several types of cancer, indicating its potential utility in clinical practice.
Low AGR and Overall Survival in Cancer Patients
General Cancer Prognosis
Multiple studies have demonstrated that a low pretreatment AGR is significantly associated with poor overall survival (OS) in cancer patients. A comprehensive meta-analysis involving 15,356 cancer patients found that low AGR was linked to worse OS, disease-free survival (DFS), and progression-free survival (PFS) across various cancer types1. This association remained consistent regardless of factors such as publication times, sample sizes, patient origins, and treatment methods.
Specific Cancer Types
Head and Neck Cancer (HNC)
In head and neck cancer, a low pretreatment AGR has been shown to predict poor survival outcomes. A meta-analysis of 3,211 HNC patients revealed that low AGR was significantly associated with poor disease-free survival, distant metastasis-free survival, and overall survival2. Additionally, low AGR correlated with advanced cancer stages and lymph node metastasis, underscoring its prognostic value in HNC management.
Gastric Cancer (GC)
For gastric cancer patients, low AGR has been identified as a predictor of poor prognosis. A meta-analysis including 8,305 GC patients indicated that low AGR was closely associated with worse OS and DFS/PFS3. This relationship held true across different countries, tumor stages, and treatment methods, suggesting that AGR could be a reliable prognostic marker in GC.
Cervical Cancer
In cervical cancer patients undergoing surgery, a low preoperative AGR was found to be an independent prognostic factor for overall survival. A study involving 247 cervical cancer patients showed that low AGR was significantly associated with poor prognosis, including higher recurrence and mortality rates4.
Renal Cell Carcinoma (RCC)
A meta-analysis of 5,671 RCC cases demonstrated that a low AGR significantly correlated with worse OS and PFS. Additionally, low AGR was associated with advanced tumor stages, lymph node involvement, and tumor necrosis, highlighting its prognostic significance in RCC5.
Prostate Cancer (PC)
In prostate cancer, the prognostic value of AGR varies between non-metastatic and metastatic cases. While low AGR did not significantly predict staging or biochemical progression in non-metastatic PC, it was a significant predictor of progression-free survival and cancer-specific survival in metastatic PC6.
Digestive System Cancers (DSCs)
A meta-analysis of 9,269 patients with digestive system cancers found that low AGR was significantly correlated with poor OS and DFS. This suggests that AGR could serve as a useful prognostic biomarker in DSCs, aiding in the prediction of patient outcomes7.
Colorectal Cancer (CRC)
In colorectal cancer, low AGR has been associated with poor OS and DFS/PFS. A meta-analysis of 8,397 CRC patients confirmed that low AGR was a significant prognostic factor for these outcomes, although it did not significantly predict cancer-specific survival8.
Urological Cancers
For urological cancers, including prostate, bladder, and kidney cancers, low AGR has been linked to poor OS, cancer-specific survival, and recurrence-free survival. This suggests that AGR could be a non-invasive predictive biomarker for these cancers9.
Conclusion
The albumin to globulin ratio (AGR) is emerging as a valuable prognostic marker in various cancers. Low AGR is consistently associated with poor survival outcomes, advanced disease stages, and higher recurrence rates across multiple cancer types. Its simplicity and cost-effectiveness make it a practical tool for predicting patient prognosis and guiding treatment decisions in clinical practice. Further large-scale prospective studies are warranted to validate these findings and establish standardized AGR cut-off values for different cancers.
Sources and full results
Most relevant research papers on this topic
Pretreatment 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-Analysis
Highly CitedLow 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-AnalysisA low preoperative albumin-to-globulin ratio is a negative prognostic factor in patients with surgically treated cervical cancer
A low albumin-to-globulin ratio is associated with a poor prognosis in patients with surgically treated invasive cervical cancer.
Observational StudyPrognostic significance of albumin-to-globulin ratio in patients with renal cell carcinoma: a meta-analysis
A low albumin-to-globulin ratio strongly predicts poor overall survival and progression-free survival in renal cell carcinoma patients, and is significantly associated with clinicopathological features indicative of disease progression.
Meta-AnalysisPrognostic Value of Albumin to Globulin Ratio in Non-Metastatic and Metastatic Prostate Cancer Patients: A Meta-Analysis and Systematic Review
The albumin to globulin ratio (AGR) has a significant predictive value for progression-free survival in metastatic prostate cancer, but no significant predictive value for staging, grading, or biochemical progression in non-metastatic prostate cancer.
Meta-AnalysisPrognostic 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-Analysis
Rigorous JournalPrognostic 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-AnalysisSerum albumin to globulin ratio prior to treatment as a potential non-invasive prognostic indicator for urological cancers
Low pretreatment albumin to globulin ratio is associated with poor prognosis in urinary system cancer patients, making it a potential non-invasive predictive biomarker.
Meta-AnalysisClinical impact of preoperative albumin to globulin ratio in gastric cancer patients with curative intent.
Low albumin-to-globulin ratio is an independent predictor of early recurrence in curative gastric cancer patients, with poor disease-free survival in those with low AGR levels.
Observational Study