Does the albumin/globulin ratio (AGR) predict prognosis in digestive system cancers? No convincing conclusions have been made, say researchers from Nan Chang University in China. They conducted a meta-analysis of 15 studies involving nearly 10,000 patients. The results indicated that a low pretreatment AGR was significantly related to worse survival outcomes for patients with colorectal and other cancers of the digestive system.
Of the analyzed studies, 13 explored the association of AGR with overall survival and found that a low AGR nearly doubled the risk of death. When the researchers adjusted for cancer type, region, sample size, treatment method, and other variables, a low AGR remained a predictor for worse overall survival in colorectal, esophageal, and gastric cancer; hazard ratios (HR) equal to 2.39, 1.35, and 1.56, respectively. Two studies explored the association of a low AGR with cancer-specific survival; again a low AGR was significantly related to worse outcome (HR = 1.61).
The researchers say effects of nutrition and inflammation may underlie the prognostic value of the AGR. They refer to the “mutual promotion effect” between cancer progression and inflammation, and to the fact that cancer patients are vulnerable to cachexia, which also contributes to tumor growth. Moreover, serum albumin reflects not only the body’s nutritional status, but also, according to recent research, the inflammatory status. The serum globulin level is closely associated with immune and inflammatory status and is easily affected by dehydration and fluid retention, common to cancer patients.
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Thus, the AGR, which accounts for both levels concurrently, may mirror nutritional and inflammatory indexes more precisely, the researchers say, and could be a helpful biomarker.
Source:
Guo HW, Yuan TZ, Chen JX, Zheng Y. PLoS One. 2018;13(1):e0189839.
doi: 10.1371/journal.pone.0189839.