Prognostic effect of preoperative serum albumin to globulin ratio in patients treated with cytoreductive nephrectomy for metastatic renal cell carcinoma
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Prognostic effect of preoperative serum albumin to globulin ratio in patients treated with cytoreductive nephrectomy for metastatic renal cell carcinoma. / 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.
In: TRANSL ANDROL UROL, Vol. 10, No. 2, 02.2021, p. 609-619.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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T1 - Prognostic effect of preoperative serum albumin to globulin ratio in patients treated with cytoreductive nephrectomy for metastatic renal cell carcinoma
AU - Laukhtina, Ekaterina
AU - Pradere, Benjamin
AU - D'Andrea, David
AU - Rosiello, Giuseppe
AU - Luzzago, Stefano
AU - Pecoraro, Angela
AU - Palumbo, Carlotta
AU - Knipper, Sophie
AU - Karakiewicz, Pierre I
AU - Margulis, Vitaly
AU - Quhal, Fahad
AU - Motlagh, Reza Sari
AU - Mostafaei, Hadi
AU - Mori, Keiichiro
AU - Schuettfort, Victor M
AU - Enikeev, Dmitry
AU - Shariat, Shahrokh F
N1 - 2021 Translational Andrology and Urology. All rights reserved.
PY - 2021/2
Y1 - 2021/2
N2 - Background: 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.Methods: 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 vs. 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).Results: 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 vs. 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).Conclusions: In our study, low AGR before CN was associated with worse OS and CSS, particularly in intermediate risk patients.
AB - Background: 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.Methods: 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 vs. 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).Results: 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 vs. 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).Conclusions: In our study, low AGR before CN was associated with worse OS and CSS, particularly in intermediate risk patients.
U2 - 10.21037/tau-20-1101
DO - 10.21037/tau-20-1101
M3 - SCORING: Journal article
C2 - 33718063
VL - 10
SP - 609
EP - 619
JO - TRANSL ANDROL UROL
JF - TRANSL ANDROL UROL
SN - 2223-4683
IS - 2
ER -
