title: The value of the pretreatment albumin/globulin ratio in predicting the long-term survival in colorectal cancer.
abstract: BACKGROUND
  Low serum albumin was found as a predictor of long-term mortality in colorectal cancer (CRC) patients. Our aim was to evaluate the value of the pretreatment albumin/globulin ratio (AGR) to predict the long-term mortality in CRC patients.
  
  
  METHODS
  Patients were included if they had comprehensive metabolic panel (CMP) before treatment (surgery or chemotherapy). The albumin/globulin ratio, routinely reported in CMP, is calculated [AGR = Albumin/(Total protein - Albumin)]. Patients were divided into three equal tertiles according to their pretreatment AGR. The primary outcome was cancer-related mortality, which was obtained from our cancer registry database.
  
  
  RESULTS
  A total of 534 consecutive CRC patients had pretreatment CMP. The 1st AGR tertile had a significant higher 4-year mortality compared to the second and third AGR tertiles (42 vs. 19 and 7 %, p < 0.0001 according to Fisher's exact two-tailed test). In the multivariate model, AGR remained an independent predictor of survival with 75 % decrease in mortality among the highest AGR tertile in comparison to the lowest AGR tertile, p < 0.0001. In the subset of 234 patients with normal serum albumin (albumin of >3.5 g/dl), serum AGR continues to be an independent predictor of cancer-related mortality with an adjusted hazard ratio of the third tertile compared to the first tertile equal to 0.05 (95 % confidence interval 0.01-0.33, p = 0.002).
  
  
  CONCLUSIONS
  Low AGR was a strong independent predictor of long-term cancer-specific survival among colorectal cancer patients. Additionally, among the patients with normal albumin (>3.5 g/dl), patients with lower globulins but higher albumin and AGR levels had better survival.
authors.affiliation: Department of Surgery, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, 10305, USA, basemnady2000@yahoo.com.
authors.forename: Basem
authors.initials: B
authors.lastname: Azab
authors.forename: Shiksha
authors.initials: S
authors.lastname: Kedia
authors.forename: Neeraj
authors.initials: N
authors.lastname: Shah
authors.forename: Steven
authors.initials: S
authors.lastname: Vonfrolio
authors.forename: William
authors.initials: W
authors.lastname: Lu
authors.forename: Ali
authors.initials: A
authors.lastname: Naboush
authors.forename: Farhan
authors.initials: F
authors.lastname: Mohammed
authors.forename: Scott W
authors.initials: SW
authors.lastname: Bloom
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000401:mortality*; D005260:Female; D005916:Globulins / Q000378:metabolism*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012709:Serum Albumin / Q000378:metabolism*
chemical_list: D005916:Globulins; D012709:Serum Albumin