New prognostic indicators in surgery

Albumin-to-alkaline phosphatase ratio as a promising indicator of prognosis in human cancers: is it possible?

Background

The impact of albumin-to-alkaline phosphatase ratio (AAPR) on prognosis in cancer patients remains uncertain, despite having multiple relevant studies in publication.

Methods

We systemically compiled literatures from 3 databases (Cochrane Library, PubMed, and Web of Science) updated to May 24th, 2020. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed and synthesized using STATA 14, values were then pooled and utilized in order to assess the overall impact of AAPR on patient’s prognosis.

Results

In total, 18 studies involving 25 cohorts with 7019 cases were incorporated. Pooled results originated from both univariate and multivariate analyses (HR = 2.14, 95%CI:1.83–2.51, random-effects model; HR = 1.93, 95%CI:1.75–2.12, fixed-effects model; respectively) suggested that decreased AAPR had adverse effect on overall survival (OS). Similarly, pooled results from both univariate and multivariate analysis of fixed-effects model, evinced that decreased AAPR also had adverse effect on disease-free survival (DFS) (HR = 1.81, 95%CI:1.60–2.04, I² = 29.5%, P = 0.174; HR = 1.69, 95%CI:1.45–1.97, I² = 13.0%, P = 0.330; respectively), progression-free survival (PFS) (HR = 1.71, 95%CI:1.31–2.22, I² = 0.0%, P = 0.754; HR = 1.90, 95%CI:1.16–3.12, I² = 0.0%, P = 0.339; respectively), and cancer-specific survival (CSS) (HR = 2.22, 95%CI:1.67–2.95, I² = 5.6%, P = 0.347; HR = 1.88, 95%CI:1.38–2.57, I² = 26.4%, P = 0.244; respectively). Admittedly, heterogeneity and publication bias existed, but stratification of univariate meta-analytic results, as well as adjusted meta-analytic results via trim and fill method, all showed that AAPR still significantly correlated with poor OS despite of confounding factors.

Conclusions

In summary, decreased AAPR had adverse effect on prognosis in cancer patients. As an inexpensive and convenient ratio derived from liver function test, AAPR might become a promising indicator of prognosis in human cancers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-07921-6.

Prognostic effect of pretreatment albumin-to-alkaline phosphatase ratio in human cancers: A meta-analysis

Purpose

It has been demonstrated that, for various types of cancer, the pretreatment albumin/alkaline phosphatase ratio (AAPR) was a prognostic factor. Therefore, in order to determine AAPR’s prognostic effect on cancer, the meta-analysis was hereby performed.

Patients and methods

The relevant studies conducted before November 10, 2019, were comprehensively searched in Web of Science, PubMed, and Embase. HRs(hazard ratios) with related 95%CIs(confidence intervals) were adopted to estimate AAPR’s prognostic impact on overall survival (OS) & disease-free survival (DFS).

Results

Our meta-analysis involved thirteen cohort studies, which included 5,204 cases of 8 types. The results of this meta-analysis indicated that higher AAPR was corrected with better OS (pooled HR = 0.52; 95%CI = 0.47–0.58; P<0.001) and DFS (pooled HR = 0.55; 95%CI = 0.47–0.66; P<0.001). Subgroup analysis on OS was based on the cancer system, treatment methods, and cutoff value. Moreover, higher AAPR was statistically in associated with lighter infiltration (pooled OR = 0.79; 95%CI = 0.73–0.85; P<0.001), no lymph nodes metastasis (pooled OR = 0.89; 95%CI = 0.83–0.95; P = 0.001), and no distant metastasis (pooled OR = 0.92; 95%CI = 0.86–0.99; P = 0.028).

Conclusion

Higher AAPR was related to better prognosis of cancer, and in cancer therapy, AAPR could be taken as a promising marker of prognosis. It might help physicians to select the most appropriate treatments by evaluating the current status of patients with cancer. Future multicenter prospective clinical trials were required to verify its applications.