title: Value of the pretreatment albumin to globulin ratio in predicting long-term mortality in breast cancer patients.
abstract: BACKGROUND
  Prior studies have demonstrated the prognostic value of pretreatment serum albumin in different types of cancer. The aim of this study was to assess the predictive value of the albumin to globulin ratio (AGR) on survival in breast cancer patients.
  
  
  METHODS
  This retrospective study used an unselected cohort of 354 breast cancer patients who had documented total protein and albumin levels prior to chemotherapy. Survival status was obtained from our cancer registry. Survival analysis, stratified by AGR tertiles, was used to evaluate the prognostic value of AGR.
  
  
  RESULTS
  Patients in the highest AGR tertiles (AGR > 1.45) had a lower 5-year mortality rate compared with those in the middle (AGR 1.21 to 1.45) and the lowest (AGR < 1.21) tertiles (6% vs. 18% and 32%, P < .001). After adjusting for confounding variables, AGR remained a significant predictor of mortality (P < .002). Moreover, after excluding the patients with albumin levels less than 3.6, the AGR remained a significant predictor of survival (P .0018).
  
  
  CONCLUSIONS
  Pretreatment AGR is an independent, significant predictor of long-term mortality in breast cancer patients, even in patients with normal albumin levels.
authors.affiliation: Department of Surgery, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA. Electronic address: basemnady2000@yahoo.com.
authors.forename: Basem N
authors.initials: BN
authors.lastname: Azab
authors.forename: Vijaya R
authors.initials: VR
authors.lastname: Bhatt
authors.forename: Steven
authors.initials: S
authors.lastname: Vonfrolio
authors.forename: Rana
authors.initials: R
authors.lastname: Bachir
authors.forename: Vladimir
authors.initials: V
authors.lastname: Rubinshteyn
authors.forename: Homam
authors.initials: H
authors.lastname: Alkaied
authors.forename: Ayman
authors.initials: A
authors.lastname: Habeshy
authors.forename: Jignesh
authors.initials: J
authors.lastname: Patel
authors.forename: Antonio I
authors.initials: AI
authors.lastname: Picon
authors.forename: Scott W
authors.initials: SW
authors.lastname: Bloom
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D018275:Carcinoma, Lobular / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis*; D012712:Serum Globulins / Q000032:analysis*
chemical_list: D012709:Serum Albumin; D012712:Serum Globulins
keywords: Albumin globulin ratio; Breast cancer; Mortality