Albumin-to-alkaline phosphatase ratio: A novel prognostic index of overall survival in cholangiocarcinoma patients after surgery

Prognostic value of preoperative albumin-to-alkaline phosphatase ratio in patients with surgically treated urological cancer: a systematic review and meta-analysis

Objective

A novel albumin-to-alkaline phosphatase ratio (AAPR) is associated with the prognosis of several cancers. In the present study, we evaluate the prognostic significance of perioperative AAPR in urological cancers.

Method

Relevant studies were searched comprehensively from CNKI, PubMed, Embase and Web of Science up to March 2023. The pooled hazard ratio (HR) and 95% confidence interval (CI) were extracted from each study to evaluate the prognostic value of perioperative AAPR in patients with surgically treated urological cancers.

Results

A total of 8 studies consisting of 3,271 patients were included in the final results. A low AAPR was significantly associated with a worse OS (HR=2.21; P<0.001), CSS (HR=2.61; P<0.001) and RFS/DFS (HR=2.87; P=0.001). Stratified by disease, a low AAPR was also associated with worse OS in renal cell carcinoma (HR=2.01; P<0.001), bladder cancer (HR=3.37; P<0.001) and upper tract urothelial carcinoma (HR=1.59; P=0.002).

Conclusion

In conclusion, low AAPR could serve as an unfavorable factor in patients with surgically treated urological cancers. Stratified by tumor type, the low AAPR was also associated with inferior survival. While more prospective and large-scale studies are warranted to validate our findings.

Prognostic effect of albumin-to-alkaline phosphatase ratio on patients with hepatocellular carcinoma: a systematic review and meta-analysis

The prognostic value of albumin-to-alkaline phosphatase ratio (AAPR) in patients with hepatocellular carcinoma (HCC) remains controversial. This meta-analysis aims to evaluate the prognostic role of AAPR in patients with HCC. The databases of Web of Science, Embase, Cochrane Library and PubMed were comprehensively searched from inception to April 25, 2022. Pooled hazard ratio (HR) and 95% confidence interval (CI) were calculated with Stata 16.0 software for the assessment of the relationship between AAPR and overall survival (OS) as well as recurrence-free survival (RFS) in patients with HCC. A total of 2634 patients from 12 cohorts were included in this meta-analysis. The pooled results showed that lower AAPR predicted poorer OS (HR 2.02, 95% CI 1.78-2.30). Similarly, pooled results demonstrated that lower AAPR also predicted poorer RFS (HR 1.88, 95% CI 1.37-2.57). The heterogeneity for RFS by multivariate analytic results and the publication bias for OS existed, however, the subgroup analysis, meta-regression analysis as well as adjustment using trim-and-fill analysis confirmed an association between AAPR and OS as well as RFS. This meta-analysis proves that lower AAPR in patients with HCC predicted inferior survival outcomes, and AAPR might be a promising indicator for the prognosis of HCC.

Prognostic Value of Combination of Controlling Nutritional Status and Tumor Marker in Patients with Radical Non-Small-Cell Lung Cancer

Background

Controlling nutritional status (CONUT) and tumor markers are associated with prognosis in patients with non-small-cell lung cancer (NSCLC). This study is aimed at exploring the potential usefulness of T-CONUT, constructed by combining CONUT and tumor markers, for NSCLC patients undergoing radical surgery.

Methods

A total of 483 patients with NSCLC underwent radical surgical resection. The receiver characteristic operating curve (ROC) was used to select the tumor marker with the highest predictive performance, and CONUT was combined with this marker to construct the T-CONUT. The Kaplan–Meier method and log-rank test were used to analyze the overall survival (OS), and chi-square analysis was used to analyze the association between T-CONUT and clinicopathological characteristics. The independent risk factors were analyzed by Cox regression. A nomogram was constructed by R studio. Calibration plots, the c-index, and decision curves were evaluated for the performance of the nomogram.

Results

ROC analysis showed that the predictive performance of CYFRA21–1 was better than that of CEA, NSE, and SCC. CYFRA21–1 was selected for combining with CONUT to construct T-CONUT. Elevated T-CONUT indicates poor prognosis of patients. Histological type, pTNM, and T-CONUT are independent risk factors associated with patient prognosis. The areas under the curve of the nomogram for predicting 3- and 5-year OS were 0.760 and 0.761, respectively.

Conclusion

T-CONUT comprising CYFRA21–1 and CONUT can effectively predict the prognosis of NSCLC patients.

Protective effect of protein hydrolysates from Litopenaeus vannamei waste on oxidative status, glucose regulation, and autophagy genes in non-alcoholic fatty liver disease in Wistar rats

Objective(s):

The effects of protein hydrolysates (FP) from Litopenaeus vannamei on oxidative stress, and autophagy gene expression was investigated in the NAFLD-induced rats.

Materials and Methods:

For this purpose, twenty-four male rats were divided into four groups: Control, High-fat diet (HFD), FP20+HFD, and FP300+HFD (20 and 300 mg FP /kg rat body weight) and fed for 70 days.

Results:

The results indicated that the rat body and relative weight of the liver were not affected by experimental treatments (P>0.05) although the highest relative weight of the liver was observed in HFD treatment. The highest and lowest values for antioxidant enzymes and MDA concentration were observed in FP treatments (P<0.05). Also, the results showed that FP significantly decreased liver enzymes (ALT, AST) in the liver in comparison with HFD treatment (P<0.05). Plasma biochemical indices were investigated and the lowest amylase, ALP, fasting glucose, insulin, HOMA-IR, triglycerides, cholesterol, and inflammation cytokines (TNF-α, IL-6) were seen in the FP treatments which had a significant difference with HFD (P<0.05). Autophagy gene expression in the liver cells was affected by experimental diets and the lowest expression of Beclin-1 and Atg7 was observed in HFD and FP300 treatments. Interestingly, the highest expression of LC3-ɪ and P62 was seen in HFD and FP treatments, not in the control.

Conclusion:

Overall, the results of this experiment indicated that FPs extracted from Whiteleg shrimp at 50 °C improve the oxidative status, glucose metabolism, and autophagy gene expression and could be used as a useful nutritional strategy in fatty liver prevention.

Prognostic importance of the preoperative New-Naples prognostic score for patients with gastric cancer

BACKGROUND

The wide applicability of the Naples prognostic score (NPS) is still worthy of further study in gastric cancer (GC). This study aimed to construct a New-NPS based on the differences in immunity and nutrition in patients with upper and lower gastrointestinal tumors to help obtain an individualized prediction of prognosis.

METHODS

This study retrospectively analyzed patients who underwent radical gastrectomy from April 2014 to September 2016. The cutoff values of the preoperative neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), serum albumin (Alb), and total cholesterol (TC) were calculated by ROC curve analysis. ROC and t-ROC were used to evaluate the accuracy of the prognostic markers. The Kaplan-Meier method and log-rank test were used to analyze the overall survival probability. Univariate and multivariate analyses based on Cox risk regression were used to show the independent predictors. The nomogram was made by R studio. The predictive accuracy of nomogram was assessed using a calibration plot, concordance index (C-index), and decision curve.

RESULTS

A total of 737 patients were included in training cohort, 411 patients were included in validation cohort. ROC showed that the New-NPS was more suitable for predicting the prognosis of GC patients. NPS = 2 indicated a poor prognosis. Multivariate analysis showed that CEA (P = 0.026), Borrmann type (P = 0.001), pTNM (P < 0.001), New-NPS (P < 0.001), and nerve infiltration (P = 0.035) were independent risk factors for prognosis.

CONCLUSION

The New-NPS based on the cutoff values of NLR, LMR, Alb, and TC is not only suitable for predicting prognosis but can also be combined with clinicopathological characteristics to construct a nomogram model for GC patients.

Prognostic significance of albumin to alkaline phosphatase ratio in critically ill patients with acute kidney injury

OBJECTIVE

No epidemiological evidence has investigated the effect of albumin to alkaline phosphatase ratio (AAPR) on the prognosis among critically ill patients with acute kidney injury (AKI). We aimed to explore the prognostic value of AAPR in these patients.

METHODS

We extracted all clinical data from MIMIC III. ROC curve analysis was used to evaluate the discrimination of AAPR for predicting in-hospital mortality. A generalized additive model was applied to identify a nonlinear association between AAPR and in-hospital mortality. The Cox proportional hazards models were used to determine the association between AAPR and in-hospital and 30-day mortality.

RESULTS

A total of 6894 eligible subjects were enrolled in this study. The relationship between AAPR and in-hospital mortality was nonlinear. Multivariate analysis demonstrated that lower AAPR (AAPR < 0.35) was an independent predictor of in-hospital and 30-day mortality after adjusting for potential confounders (HR 1.74, 95% CI 1.72-2.20, P < 0.001; HR 1.89, 95% CI 1.66-2.14, P < 0.001, respectively).

CONCLUSIONS

AAPR may serve as a potential prognostic biomarker in critically ill patients with AKI and lower AAPR was associated with increased risk of in-hospital and 30-day mortality among these patients.

The Prognostic Value of Preoperative Albumin-to-Alkaline Phosphatase Ratio on Survival Outcome for Patients With Locally Advanced Oral Squamous Cell Carcinoma

Background: This retrospective cohort study was to assess the prognostic value of preoperative albumin-to-alkaline phosphatase ratio (AAPR) on survival outcome for patients with locally advanced oral squamous cell carcinoma (LAOSCC). Methods: A total of 250 patients with LAOSCC receiving upfront radical surgery at a single institute from January 2008 to December 2017 were enrolled. The primary endpoint was the survival predictability of preoperative AAPR on the 5-year overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Cox proportional hazards model was used for survival analysis. The X-tile software was used to estimate the optimal cut-off value of preoperative AAPR on survival prediction. A predictive nomogram incorporating the clinicopathological factors on OS was further generated. Results: The 5-year OS, CSS, and DFS rates were 68.6%, 79.7%, and 61.7%, respectively. The optimal cut-off of preoperative AAPR to predict the 5-year OS was observed to be 0.51. For those with preoperative AAPR≧0.51, the 5-year OS, CSS, and DFS were statistically significantly superior to those with preoperative AAPR<0.51 (OS: 76.1% vs 48.5%, P < .001; CSS: 84.3% vs 66.4%, P = .005; DFS: 68.9% vs 42.6%, P < .001). In Cox model, we observed that preoperative AAPR<0.51 was a significantly negative prognosticator of OS (HR: 2.22, 95% CI: 1.466-3.361, P < .001), CSS (HR: 2.037, 95% CI: 1.16-3.578, P  = .013), and DFS (HR: 1.756, 95% CI: 1.075-2.868, P  = .025). After adding the variable of preoperative AAPR, the c-index of the predictive nomogram incorporating assorted clinicopathological factors increases from 0.663 to 0.692 for OS. Conclusion: Our results suggest that preoperative AAPR serves as an independent survival predictor for patients with LAOSCC. The nomogram incorporating preoperative AAPR and various clinicopathological features may be a convenient tool to estimate the mortality risk for patients with LAOSCC.

Albumin-To-Alkaline Phosphatase Ratio as a Novel and Promising Prognostic Biomarker in Patients Undergoing Esophagectomy for Carcinoma: A Propensity Score Matching Study

Background

Albumin-to-alkaline phosphatase ratio (AAPR) has been reported as a novel prognostic predictor for numerous solid tumors. We aimed to assess the prognostic role of preoperative AAPR in surgically resectable esophageal squamous cell carcinoma (ESCC) by a propensity score matching (PSM) analysis with predictive nomograms.

Methods

Our study was conducted in a single-center prospective database between June 2009 and December 2012. Kaplan-Meier analysis was used to distinguish the difference in survival outcomes between patients stratified by an AAPR threshold. Multivariable Cox proportional hazards regression model was finally generated to specify independent prognostic markers for the entire and PSM cohorts.

Results

A total of 497 patients with ESCC were included in this study. An AAPR of 0.50 was determined as the optimal cutoff point for prognostic outcome stratification. Patients with AAPR<0.50 had significantly worse overall survival (OS), and progression-free survival (PFS) compared to those with AAPR≥0.50 (Log-rank P<0.001). This significant difference remained stable in the PSM analysis. Multivariable analyses based on the entire and PSM cohorts consistently showed that AAPR<0.50 might be one of the most predominant prognostic factors resulting in unfavorable OS and PFS of ESCC patients undergoing esophagectomy (P<0.001). The nomograms consisting of AAPR and other independent prognostic factors further demonstrated a plausible predictive accuracy of postoperative OS and PFS.

Conclusion

AAPR can be considered as a simple, convenient and noninvasive biomarker with a significant prognostic effect in surgically resected ESCC.

Decreased albumin-to-alkaline phosphatase ratio predicted poor survival of resectable gastric cancer patients

Background

The albumin-to-alkaline phosphatase ratio (AAPR) is an innovative prognostic index for various cancer patients, the clinical significance of the AAPR in patients with GC is unknown.

Methods

We retrospectively reviewed 227 resectable GC patients in our center. The Kaplan-Meier method and the Cox proportional hazards model were used to analyze the disease-free survival (DFS) and overall survival (OS). The Likelihood Ratio Test (LRT) and Akaike information criterion (AIC) were used to compare the prognostic abilities of the TNM and AAPR-TNM staging systems in DFS and OS prediction.

Results

The AAPR was significantly decreased in GC patients, and the optimal cut-off value for resectable and benign gastric disease was 0.437 as determined by the receiver operating characteristic (ROC) curve. The correlation analysis revealed that decreased AAPR in GC was associated with T stage (P=0.004) and TNM stage (P=0.013). Decreased preoperative AAPR correlated with both unfavorable disease-free survival (DFS) and overall survival (OS). Cox regression analysis showed that the TNM stage (DFS: P=0.001, OS: P=0.002) and differential levels of AAPR (DFS: P<0.001, OS: P<0.001) were independent risk factors of DFS and OS. ROC analysis showed that the AAPR-TNM system was more superior than the TNM staging system for DFS (z=1.91, P=0.028) and OS (z=1.937, P=0.026) prediction. The likelihood ratio test (LRT) analysis indicated that the AAPR-TNM system had a significantly larger χ² for both DFS (35.58 vs. 34.51, P<0.001) and OS (32.92 vs. 30.07, P<0.001), and a lower Akaike information criterion (AIC) value both for DFS (1,032 vs. 1,065, P<0.001) and OS (869 vs. 898, P<0.001) compared to the TNM system.

Conclusions

The AAPR level significantly decreased in patients with GC, and impacted the prognosis of patients.

Prognostic Significance of Preoperative Albumin to Alkaline Phosphatase Ratio in Patients with Glioblastoma

Objective: To explore the prognostic value of preoperative albumin to alkaline phosphatase ratio (AAPR) in patients with newly-diagnosed glioblastoma (GBM) and its association with clinical characteristics. Patients and methods: A retrospective analysis was carried out on patients with newly diagnosed GBM who had undergone operation at the Department of Neurosurgery at West China Hospital between June 1st 2016 to December 31st 2018. X-tile software was applied to determine the optimal cut-off values for AAPR, neutrophil to lymphocyte ratio (NLR), and albumin. Cox regression analyses were applied to evaluate the prognostic value of AAPR in GBM. PSM analysis was conducted to verify the results. Results: A total of 197 and 154 GBM patients were included in original cohort and PSM cohort respectively. The optimal cut-off value for AAPR, NLR, and albumin were 0.56, 4.55 and 42.2 g/L respectively. High AAPR was only significantly related to longer overall survival (OS) (p=0.010) in original cohort. In PSM cohort, no clinical variable was evidently related to the level of AAPR. AAPR was determined to be an independent prognostic indicator in both original cohort (HR=0.599, 95%CI 0.437-0.822, p=0.001) and PSM cohort (HR=0.649, 95%CI 0.459-0.918, p=0.015). Prognostic models including AAPR had better prognostic accuracy than that including albumin. Conclusion: Preoperative AAPR was determined to be an independent risk factor of prognosis in newly-diagnosed GBM patients, and its prognostic ability was stronger than albumin. And PSM analysis also validated the results.

Albumin-to-alkaline phosphatase ratio as a predictor of tumor recurrence and prognosis in patients with early-stage hepatocellular carcinoma undergoing radiofrequency ablation as initial therapy

OBJECTIVE

Albumin-to-alkaline phosphatase ratio (AAPR), a newly developed blood biomarker, has been reported to have prognostic value in several types of cancer. This study aimed to investigate the predictive value of AAPR in patients with early-stage hepatocellular carcinoma (HCC) undergoing radiofrequency ablation (RFA) as initial therapy.

METHODS

This retrospective study analyzed 445 patients with newly diagnosed HCC undergoing RFA as initial therapy. A series of survival analyses were performed to evaluate the prognostic value of AAPR. Univariate and multivariate analyses were performed to identify independent prognostic factors. An AAPR-based nomogram was constructed, and its predictive performance was validated.

RESULTS

Patients with a low AAPR had a significantly reduced recurrence-free survival (RFS) and overall survival (OS) compared with those with a high AAPR. AAPR was found to be an independent prognostic indicator and showed superior discrimination efficacy than other liver function indices. The AAPR-based nomogram had a concordance index value of 0.72 (95% confidence interval [CI]: 0.65-0.79) in the training cohort and 0.72 (95% CI: 0.63-0.81) in the validation cohort, which significantly outperformed other existing staging systems.

CONCLUSIONS

AAPR serves as a promising indicator of prognosis in patients with early-stage HCC undergoing RFA. The AAPR-based nomogram might contribute to individualized prognosis prediction and clinical decision making.

Combining PD-1 Inhibitor with VEGF/VEGFR2 Inhibitor in Chemotherapy: Report of a Patient with End-Stage Cholangiocarcinoma and Review of Literature

BACKGROUND

Cholangiocarcinoma is the second-largest liver cancer, and develops from the biliary epithelium, where it discretely progresses. Unfortunately, many patients miss the opportunity of performing surgery when diagnosed with cholangiocarcinoma, and due to its chemotherapeutic insensitivity, its control has always been considered difficult.

OBJECTIVE

Here, we present a case of stage 4 cholangiocarcinoma being controlled by the combination of chemotherapy with PD-1 and VEGF/VEGFR2 inhibitors.

CASE PRESENTATION

The patient is a 58-year-old male who was diagnosed with a progressed cholangiocarcinoma 2 years ago. From the beginning, metastases were discovered in multiple places, and the patient was unsuccessfully treated with 3 chemotherapy regimens. Therefore, a new therapeutic method was considered, and that involved the testing of a new combination of chemotherapy with PD-1 and VEGF/VEGFR2 inhibitors.

RESULTS

After 6 courses of treatment with this combination, the patient's lesions became smaller and stable.

CONCLUSION

Our case highlights the possibility of combining chemotherapy with PD-1 and VEGF/ VEGFR2 inhibitors for the treatment of cholangiocarcinoma patients. This combination may herald new hope for patients who run out of regimens.

Prognostic Utility of Prechemoradiotherapy Albumin-to-Alkaline Phosphatase Ratio in Unresectable Locally Advanced Pancreatic Carcinoma Patients

Background

We investigated the prognostic usefulness of prechemoradiotherapy (CRT) albumin-to-alkaline phosphatase ratio (AAPR) in unresectable locally advanced pancreatic adenocarcinoma (LAPAC) patients managed with definitive concurrent CRT (CCRT).

Methods

A sum of 136 LAPAC patients who consecutively underwent definitive CCRT was retrospectively analyzed. The AAPR (serum albumin (g/dL)/serum alkaline phosphatase (IU/L)) was calculated by using the parameters obtained from the routine biochemistry tests on the first day of the CCRT. Ideal AAPR cutoff was sought by utilizing receiver operating characteristic (ROC) curve analysis. The primary and secondary endpoints were the impact of the AAPR on the overall survival (OS) and progression-free survival (PFS) results, respectively.

Results

At a median follow-up of 14.8 months (range: 3.2-85.7), the median PFS and OS times were 7.5 (95% confidence interval (CI): 6.0-9.0) and 14.9 months (95% CI: 11.9-17.9), respectively. The ideal common AAPR cutoff was identified at the rounded 0.46 (area under the curve: 72.3%; sensitivity: 71.2%; specificity: 70.3%) point that dichotomized the patients into two groups: low AAPR (L-AAPR; N = 71) and high AAPR (H-AAPR; N = 65) groups, respectively. Comparative survival analyses showed that the L-AAPR cohort had significantly shorter median PFS (6.8 (95% CI: 5.7-7.9) versus 11.3 (95% CI: 9.9-12.7) months; P = 0.005) and OS (12.8 (95% CI: 10.6-15.0) versus 19.2 (95% CI: 16.9-21.5) months; P = 0.001) durations than their H-AAPR counterparts, separately. Albeit the N1-2 (P = 0.004) and CA 19‐9 > 90 U/mL (P = 0.008) were also found to be associated with inferior outcomes, yet the results of the multivariate analyses ascertained the L-AAPR as an independent indicator of diminished PFS (P = 0.003) and OS (P = 0.002) results.

Conclusion

The present results proposed that the pretreatment AAPR < 0.46 was a novel independent indicator of adverse PFS and OS in unresectable LAPAC patients undergoing definitive CCRT.

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.

Albumin-to-Alkaline Phosphatase Ratio: Does It Predict Survival in Grade 1 and Grade 2 Neuroendocrine Tumors?

OBJECTIVES

Neuroendocrine tumors (NETs) are very heterogeneous tumors. This study aimed to evaluate prognostic value of an albumin-to-alkaline phosphatase (ALP) ratio (AAPR) in well-differentiated NETs.

METHODS

A total of 110 patients were included in this study. Albumin-to-alkaline phosphatase ratio was calculated by dividing albumin concentration (g/dL) to ALP level (U/L). Cutoff value for AAPR was determined by receiver operating characteristic analysis. Survival analysis was performed by Kaplan-Meier method with the log-rank test. A P value of less than 0.05 was considered statistically significant.

RESULTS

The optimum cutoff value for AAPR was 0.028. Patients were divided into 2 groups as patients with AAPR of 0.028 or less (n = 22, 20%) and with AAPR of greater than 0.028 (n = 88, 80%). Patients with AAPR of greater than 0.028 had statistically longer overall survival compared with patients with 0.028 or less (not reached vs 96.8 months, P = 0.001). In addition, AAPR has been shown to be an independent prognostic factor for overall survival in multivariate analysis (hazard ratio, 3.99; 95% confidence interval, 1.26-12.61, P = 0.018).

CONCLUSIONS

Patients with higher AAPR had more favorable prognosis compared with patients with lower AAPR. We demonstrated that AAPR can be of prognostic value in well-differentiated NETs.

Prognostic Importance of the Preoperative Naples Prognostic Score for Patients With Adenocarcinoma of the Esophagogastric Junction

Background

The naples prognostic score (NPS) is established according to nutritional or inflammatory state, and it is identified as the new prognostic score for a variety of malignant tumors. However, its significance in cases suffering from adenocarcinoma of esophagogastric junction (AEJ) who receive surgery remains unclear so far.

Methods

In this study, patients receiving surgery without preoperative therapy were examined between June 2007 and August 2017 in a retrospective way. Typically, the serum albumin level, total cholesterol level, neutrophil-to-lymphocyte ratio, together with the lymphocyte-to-monocyte ratio, was determined to calculate the NPS. The prognostic impact of NPS was evaluated using survival analyses. Time-dependent receiver operating characteristic curve (t-ROC) analysis was also carried out for comparing prognostic impacts of those scoring systems.

Results

Altogether 231 cases were enrolled in this study. A higher NPS showed positive correlation with perineural invasion. Upon multivariate analysis, NPS was identified to be the independent prognostic factor to predict overall survival (OS) along with relapse-free survival (RFS) (both P< 0.05), and an especially strong correlation was observed at advanced pTNM stages based on NPS system. As for subgroup analyses on adjuvant chemotherapy or surgery only, NPS still independently predicted the OS as well as RFS (both P< 0.05) in both groups. Furthermore, t-ROC analysis showed that NPS was more accurate than the systemic inflammation score in predicting OS and RFS.

Conclusions

The NPS represents the simple and useful rating system, which can independently predict the survival for AEJ cases undergoing surgery.

Prognostic Value of Pretreatment Albumin-to-Alkaline Phosphatase Ratio in Cancer: A Meta-Analysis

Background

Recently, it has been reported that the pretreatment albumin-to-alkaline phosphatase ratio (AAPR) is related to the prognosis of various cancers. The purpose of this systematic review and meta-analysis was to explore the prognostic value of pretreatment AAPR on clinical outcomes in cancer.

Methods

PubMed, Web of Science, Cochrane Library, and Embase were systematically searched for relevant research before May 2020. Stata 12 was utilized to extract the data and the characteristics of each study and to generate a pooled hazard ratio (HR) and 95% confidence interval (CI) to assess the relationship between pretreatment AAPR and survival outcomes.

Results

We included 16 eligible published articles involving 5,716 patients. We found that low pretreatment AAPR was associated with poor overall survival (HR = 2.12, 95% CI: 1.80–2.50, P < 0.001), cancer-specific survival (HR = 2.89, 95% CI: 1.46–5.71, P < 0.001), disease-free survival (HR = 1.91, 95% CI: 1.43–2.53, P < 0.001), and progression-free survival (HR = 1.93, 95% CI: 1.49–2.52, P < 0.001). However, there was no statistical relationship between pretreatment AAPR and recurrence-free survival, distant-metastasis-free survival, or locoregional relapse-free survival. The correlation between pretreatment AAPR and overall survival did not change significantly when possible confounders were stratified. The sensitivity analysis showed that this study was reliable.

Conclusions

Low pretreatment AAPR was significantly associated with adverse clinical outcomes of cancer. Pretreatment AAPR could be a valuable noninvasive prognostic indicator for cancer.

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.

Pretreatment albumin-to-alkaline phosphatase ratio as a prognostic indicator in solid cancers: A meta-analysis with trial sequential analysis

BACKGROUND

Albumin-to-alkaline phosphatase ratio (AAPR), a novel and economic serum biomarker, is associated with survival in patients with cancer. This study aimed to evaluate the potential role of AAPR as a prognostic indicator of solid cancers.

METHODS

This meta-analysis with trial sequential analysis of retrospective studies was designed to investigate the relationship between AAPR and overall survival (OS) in solid cancers. The meta-analysis included 5951 patients from 20 cohorts. The main predictor variable was AAPR, and the main outcome was OS. Statistical tests were performed using Stata 12.0, Revman 5.3, and R 3.6.1.

RESULTS

Compared to patients with a lower AAPR, those with a higher AAPR had a better OS (hazard ratio [HR]: 0.50; 95% confidence interval [CI]: 0.43-0.58; p < 0.001). Subgroup analysis by tumor type indicated that a higher AAPR was associated with a better OS in non-small cell lung cancer (HR: 0.45; 95% CI: 0.26-0.78; p < 0.001), small cell lung cancer (HR: 0.60; 95% CI: 0.44-0.82; p < 0.001), hepatocellular carcinoma (HR: 0.49; 95% CI: 0.34-0.69; p < 0.001), pancreatic ductal adenocarcinoma (HR: 0.47; 95% CI: 0.31-0.71; p < 0.001), and nasopharyngeal carcinoma (HR: 0.42; 95% CI: 0.21-0.85; p = 0.016).

CONCLUSION

Pretreatment AAPR may be a useful prognostic indicator in solid cancers.

Predictive value of pretreatment albumin-to-alkaline phosphatase ratio for overall survival for patients with advanced non-small cell lung cancer

Objectives

To investigate the relation between AAPR and OS in patients with advanced non‐small cell lung cancer (NSCLC).

Methods

A retrospective cohort study was conducted with 808 patients with advanced NSCLC who were treated in Guangxi Medical University Affiliated Tumor Hospital in China from 5 March 2009 to 31 August 2018. The target‐independent and dependent variables were AAPR measured in patients before anticancer treatment and overall survival (OS), respectively. Covariates involved in this study included age, gender, ECOG status, smoking history, clinical stages, pathological type, driver mutation (EGFR or ALK), metastasis or not (bone, lung, liver, brain, malignant plural effusion, and other organs), number of organ metastasis(≤3, >3), first‐line regiment and number of treatment lines (≤3, >3).

Results

The mean age of the selected patients was 58.3 ± 10.9 years and 68.6% were male. We divided patients according to their AAPR into low (AAPR < 0.34, n = 266), medium (AAPR = 0.34‐0.47, n = 259), and high (AAPR > 0.47, n = 283) tertile groups. Medium and high AAPR were associated with a decreased risk of death after fully adjusted Cox proportional hazard model(s) with hazards ratio (HR) 0.77 (95%CI = 0.58‐1.03) and HR 0.59 (95%CI = 0.45‐0.78), respectively (P for trend <.05). The median OS of low, medium, and high AAPR was 9.3, 11.8, and 16.9 months, respectively (P value <.0001). No optimal cutoff value of AAPR for prognosing OS was identified by smooth curve fitting. The HR and the 95% confidence intervals of the left and right sides of the inflection point 0.6 as cutoff value were 0.28 (95%CI = 0.14‐0.57) and 0.77 (95%CI = 0.34‐1.73), respectively (P value = .127). By subgroup analysis, similar results were consistently observed across nearly all the subgroups.

Conclusion

Our study implied that pretreatment AAPR can be used as an independent prognostic factor in patients with advanced NSCLC. This ratio should be applied for risk stratification and clinical decision‐making in those patients.

Albumin-to-Alkaline Phosphatase Ratio is an Independent Prognostic Indicator in Combined Hepatocellular and Cholangiocarcinoma

Background: The clinical significance of Albumin-to-Alkaline Phosphatase Ratio (AAPR) has been discussed in hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). The aim of this study is to clarify the prognostic value of AAPR in patients with combined hepatocellular and cholangiocarcinoma (cHCC-CCA). Methods: A total of 267 patients pathologically diagnosed as Allen type C cHCC-CCA in our institution were retrospectively enrolled and randomly divided into the training (N=187) cohort and validation (N=80) cohort. The prognostic value of AAPR was evaluated and validated. An AAPR-based nomogram was constructed and its prediction performance was assessed. Results: We identified 0.43 as the optimal threshold value of AAPR by the X-tile software. In the training cohort, the median overall survival (OS) of patients with AAPR < 0.43 was significant shorter than that of those with AAPR ≥ 0.43(15.8 months vs 35 months, respectively, P < 0.001). Univariate and multivariate analyses demonstrated that AAPR was a strong indicator of OS. The concordance index (C-index), receiver operating characteristic (ROC) curves, likelihood ratio tests (LAT), Akaike information criteria (AIC) and decision curve analysis (DCA) demonstrated that AAPR outperformed the Child-Pugh (CP) grade and albumin-bilirubin (ALBI) grade in predicting OS. These findings were further verified in the validation cohort. The AAPR-based nomogram achieved C-index values of 0.76 (95%CI: 0.71-0.81) in the training cohort and 0.69 (95%CI: 0.60-0.78) in the validation cohort, which presented significant superiority to TNM stage. Conclusions: Preoperative AAPR is an independent prognostic predictor in cHCC-CCA. The AAPR-based nomogram contributes to personalized prognosis prediction and clinical decision making for cHCC-CCA.

Albumin-to-alkaline phosphatase ratio serves as a prognostic indicator in unresectable pancreatic ductal adenocarcinoma: a propensity score matching analysis

BACKGROUND

Recent evidence suggests that albumin-to-Alkaline Phosphatase Ratio (AAPR) functions as a novel prognostic marker in several malignancies. However, whether it can predict the prognosis of unresectable pancreatic ductal adenocarcinoma (PDAC) remains unclear. Herein, we seek to investigate this possibility by a propensity score matching (PSM) analysis.

METHODS

This was a retrospective cohort study in which 419 patients diagnosed with unresectable PDAC and receiving chemotherapy were recruited. Patients were stratified based on the cutoff value of AAPR. The PSM analysis was performed to identify 156 well-balanced patients in each group for overall survival (OS) comparison and subgroup analysis. Univariate and multivariate analyses were carried out to examine the potential of AAPR to indicate the prognosis of unresectable PDAC. The prediction performance of conventional model and combined model including AAPR was compared using the Akaike Information Criterion (AIC) and concordance index (C-index).

RESULTS

We identified an AAPR of 0.4 to be the optimal cutoff for OS prediction. Patients with AAPR≤0.4 had significantly shorter OS compared with patients with AAPR> 0.4 (6.4 versus 9.3 months; P < 0.001). Based on the PSM cohort and entire cohort, multivariate Cox analysis revealed that high pretreatment for AAPR was an independent marker predicting favorable survival in unresectable PDAC (hazard ratio, 0.556; 95% confidence interval, 0.408 to 0.757; P < 0.001). Significant differences in OS were observed in all subgroups except for the group of patients age ≤ 60. Combined prognostic model including AAPR had lower AIC and higher C-index than conventional prognostic model.

CONCLUSIONS

Pretreatment AAPR servers as an independent prognostic indicator for patients with unresectable PDAC. Inclusion of AAPR improved the prediction performance of conventional prognostic model, potentially helping clinicians to identify patients at high risk and guide individualized treatment.

Albumin-to-Alkaline Phosphatase Ratio Associates with Good Prognosis of Hepatitis B Virus-Positive HCC Patients

Purpose

The aim of this study was to investigate the prognostic significance of preoperative AAPR in hepatitis B virus-related hepatocellular carcinoma patients after curative hepatectomy.

Patients and Methods

A total of 221 patients with hepatitis B virus-related HCC patients who received curative liver resection were included. After propensity matching analysis, 188 patients were enrolled in the final analysis. COX regression analyses were used to analyze the prognosis value of AAPR and other prognostic factors. The overall survival (OS) and recurrence-free survival (RFS) curves were constructed and compared between different groups.

Results

The optimal cutoff of AAPR was defined as 0.40 with X-tile software. According to cutoff value, patients were divided into low-AAPR group (≤0.40) and high-AAPR group (>0.40). The cumulative 1-, 3-, and 5-year OS rates were 97.1%, 78.2%, and 67.3% in patients with AAPR>0.40 group, respectively, which were significantly higher than those in the AAPR≤0.40 group (80.2%, 54.4%, and 40.1%, respectively) (P <0.001). In the multivariate COX regression analysis, AAPR, tumor number, ascites, and portal vein tumor thrombus (PVTT) were independent risk factors for OS and RFS.

Conclusion

AAPR shows promise as a reliable prognostic factor in patients with hepatitis B virus-related HCC after curative hepatectomy, which could be used as a routine inspection of HCC patients before surgery.

Prognostic Value of Pretreatment Albumin-to-Alkaline Phosphatase Ratio in Extensive-Disease Small-Cell Lung Cancer: A Retrospective Cohort Study

PURPOSE

Evidence regarding the relationship between albumin-to-alkaline phosphatase ratio (AAPR) and overall survival (OS) in extensive-disease small-cell lung cancer (ED-SCLC) patients is limited. This study aimed to investigate whether AAPR was independently related to OS in ED-SCLC patients after adjusting for potential covariates.

PATIENTS AND METHODS

This was a retrospective cohort study of 224 patients with ED-SCLC. The target independent and dependent variables were pretreatment AAPR and OS, respectively. Covariates included age; sex; Eastern Cooperative Oncology performance status score; smoking history; existence of metastasis to organs such as the bone, lung, liver, brain, malignant plural effusion and others; sum of organ metastasis (≤3, >3), evaluation of first-line treatment; and sum of treatment lines (<2, ≥2). Student's t test or chi-squared test was used to analyze the associations between AAPR and clinical characteristics. Kaplan-Meier survival analysis and Cox's proportional hazards regression model were used to assess the prognostic value of AAPR for OS.

RESULTS

The average patient age was 60.51±8.73 years, and 87.95% were men. A non-linear relationship between AAPR and OS was detected, with an inflection point of 0.35. The hazard ratios (HRs) of the left (AAPR <0.35) and right sides (AAPR ≥0.35) of inflection point were 0.04 (95% CI=0.00-0.70, p=0.0268) and 0.52 (95% CI=0.16-1.64, p=0.2659), respectively. Kaplan-Meier analysis showed a median OS of 9.73 months (95% CI=8.6-12.33) for AAPR <0.35 and 13.7 months (95% CI=11.43-16.37) for AAPR ≥0.35 (log-rank p<0.0001). The Cox proportional hazards model showed that AAPR <0.35 increased the risk of death after adjusting for potential confounders (HR=1.65, 95% CI=1.11-2.46). In subgroup analysis, the trends of HRs were increased across all subgroups with AAPR <0.35 after stratification.

CONCLUSION

Pretreatment AAPR might be served as an independent prognostic indicator in ED-SCLC patients. Our findings should be further validated in large-scale and prospective clinical trials.

Simple Clinical Metrics Enhance AFP to Effectively Identify Cirrhotic Patients With Complicating Hepatocellular Carcinoma at Various AFP Levels

Background: Hepatocellular carcinoma (HCC) frequently occurs in cirrhosis and closely relates to poor prognosis of cirrhotic patients. Alpha-fetoprotein (AFP) is the most widely used biomarker in HCC diagnosis but not sensitive and specific to detect HCC at low AFP levels. In order to enhance the ability of AFP to detect HCC developed on cirrhosis, we attempted to combine AFP with conventional clinical metrics to develop a simple and effective method for identifying cirrhotic patients with complicating HCC at various AFP levels.

Methods: Cirrhotic patients with or without HCC hospitalized to receive therapy for the first time were recruited and their clinical data were retrospectively collected. A model for diagnosing HCC was developed with routine clinical metrics and AFP by binary logistic regression analysis and internally validated. The goodness of fit, diagnostic accuracy and clinical usefulness of the model were evaluated using a calibration curve, the area under the receiver operating characteristic curve (AUROC) and a decision curve analysis, respectively.

Results: A total of 574 patients with cirrhosis mainly caused by hepatitis B were recruited in this study, including 286 cases of simple cirrhosis (LC) and 288 cases of cirrhosis with HCC (LCC) (124 AFP-negative), with an average age of 53.2 ± 12.1 years and 81.4% males. Twelve of the 19 clinical metrics (age, gender, AFP, liver function tests, serum electrolytes, and coagulation tests) significantly differed between the LC and LCC groups. A model was successfully developed with age, AFP, Na⁺, Cl⁻, alkaline phosphatase, and activated partial thromboplastin time, which exhibited good performance in diagnosing LCC, with an AUROC of 0.918 (95%CI 0.895–0.940), 82.3% sensitivity, 89.5% specificity, and 85.9% accuracy for all patients, which were much higher values than those for AFP [0.846 (95%CI 0.815–0.878), 72.9, 81.5, and 77.2%, respectively]. For cirrhotic patients complicated with AFP-negative HCC, the model showed an AUROC of 0.854 (95%CI 0.812–0.896), 68.5% sensitivity, 86.6% specificity, and 80.0% accuracy. A high net benefit could be obtained in clinical decision making according to the model.

Conclusion: A diagnostic model combining simple clinical metrics with AFP is valuable for the identification of cirrhotic patients complicating HCC with various AFP levels.

A Novel Prognostic Scoring Model Based on Albumin and γ-Glutamyltransferase for Hepatocellular Carcinoma Prognosis

Aim

To investigate the predictive value of albumin (ALB) and γ-glutamyltransferase (GGT) in hepatocellular carcinoma (HCC) patients undergoing curative resection. We sought to establish a new scoring model for predicting the prognosis of HCC patients undergoing curative resection.

Patients and methods

A retrospective analysis was performed in 303 HCC patients who underwent curative resection. Preoperative risk factors for survival were investigated using univariate and multivariate analyses. On the basis of significant factors, a prognostic scoring model was established. The overall survival (OS) and recurrence-free survival (RFS) were compared between different groups.

Results

Multivariate Cox regression showed that preoperative decreased ALB levels and elevated GGT levels were significantly associated with poor OS and RFS. Multivariate analysis showed that ALB level, GGT level, portal vein tumor thrombus, and tumor number were independent prognostic factors for both OS and RFS. Thereafter, we established a preoperative prognostic scoring model combining the four risk factors. The results revealed that higher risk scores might mean worse OS and RFS.

Conclusion

Preoperative ALB and GGT levels are potentially useful biomarkers for predicting the prognostic outcomes in HCC patients undergoing curative resection. Our new prognostic scoring model qualifies as a novel prognostic predictor for HCC patients after curative resection.

Albumin-to-alkaline phosphatase ratio as a novel prognostic indicator for patients undergoing minimally invasive lung cancer surgery: Propensity score matching analysis using a prospective database

OBJECTIVES

To evaluate prognostic significance of albumin-to-alkaline phosphatase ratio (AAPR) for patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for non-small-cell lung cancer (NSCLC) by a propensity score-matching (PSM) analysis.

METHODS

This PSM study was conducted on the prospectively-maintained database in our institution between December 2013 and March 2015. Overall survival analyses and further subgroup analyses were both performed to distinguish the differences in postoperative survival between patients stratified by an optimal cutoff of AAPR. Multivariable Cox proportional hazards regression models were established to determine the independent prognostic factors.

RESULTS

There were 390 patients with operable NSCLCs included. An AAPR of 0.57 was identified as the optimal cutoff regarding to postoperative survival. Both overall survival (OS) and disease-free survival (DFS) in patients with AAPR≤0.57 were significantly shortened compared to those in patient with AAPR>0.57 (Log-rank P < 0.001). Patients with AAPR≤0.57 had significantly lower rates of OS and DFS than those of patients with AAPR>0.57 (P < 0.001). These differences still remained significant after subgroup analyses and PSM analyses. Multivariate analyses on the entire cohort and the PSM cohort commonly indicated that low preoperative AAPR could be an independent prognostic factor for unfavorable OS and DFS of resected NSCLCs.

CONCLUSIONS

AAPR can serve as a novel risk stratification tool to refine prognostic prediction for surgical NSCLC. It may help surgeons to screen high-surgical-risk patients and further formulate individualized treatment schemes.