Preoperative albumin to globulin ratio predicts survival in clear cell renal cell carcinoma patients

// Zhen Chen 1, * , Yingjie Shao 2, * , Hongwei Yao 1 , Qianfeng Zhuang 1 , Kun Wang 1 , Zhaoyu Xing 1 , Xianlin Xu 3, * , Xiaozhou He 1, * and Renfang Xu 1, * 1 Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, P.R. China 2 Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, P.R. China 3 Department of Urology, Sir Run Run Shaw Hospital, Third Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, P.R. China * These authors contributed equally to this work Correspondence to: Xianlin Xu, email: xuxianlincz@163.com Xiaozhou He, email: 151363683@qq.com Renfang Xu, email: xurenfangcz@163.com Keywords: albumin, globulin, nomogram, prognosis, renal cell carcinoma Received: February 22, 2016      Accepted: January 16, 2017      Published: February 07, 2017 ABSTRACT In this retrospective analysis, we evaluated associations between albumin to globulin ratio (AGR), clinicopathological characteristics, and survival in 592 patients with localized or locally advanced clear cell renal cell carcinoma (CCRCC) prior to nephrectomy. We found that low AGR was associated with more aggressive tumor behavior; patients with low AGR had poorer overall survival (OS) and cancer-specific survival (CSS) in Kaplan-Meier survival analyses both before and after propensity score matching, which was used to compensate for differences in baseline clinicopathological characteristics. AGR was an independent prognostic factor for both OS (HR: 6.799; 95% CI: 3.215−14.377; P < 0.001) and CSS (HR: 8.806; 95% CI: 3.891−19.928; P < 0.001), and its prognostic value was higher than that of other established inflammation-based prognostic scores. When AGR was incorporated into a prognostic model that included T stage, neutrophil to lymphocyte ratio (NLR), and monocyte to lymphocyte ratio (MLR), the resulting nomogram predicted 3- and 5-year OS in the patients more accurately than when AGR was not included. In conclusion, AGR may be particularly useful for improving clinical outcome predictions for patients with localized or locally advanced CCRCC.