title: Prognostic Significance of Preoperative Albumin-Globulin Ratio in Patients with Upper Tract Urothelial Carcinoma.
abstract: BACKGROUND
  Preoperative albumin-globulin ratio (AGR) reflects both malnutrition and systemic inflammation in cancer patients. In particular, systemic inflammation has been reported to contribute to tumor progression and poor oncological outcome in various malignancies. However, the prognostic value of preoperative AGR in upper tract urothelial carcinoma (UTUC) has not been examined.
  
  
  METHODS
  We retrospectively reviewed medical data of 187 operable UTUC patients in a Chinese cohort with a high incidence of chronic kidney disease (CKD). AGR was calculated as [AGR = albumin/(serum total protein-albumin)]. The associations of preoperative AGR with clinicopathologic characteristics and prognosis were assessed. Multivariate analyses using Cox regression models were performed to determine the independent prognostic factors.
  
  
  RESULTS
  The median (IQR) preoperative AGR was 1.50 (1.30-1.70), and the optimal cutoff value was determined to be 1.45 according to the receiver operating curve analysis. Low AGR was significantly associated with female gender, high CKD stage and tumor grade (P < 0.05). Eighty-three patients died before the follow-up endpoint. Kaplan-Meier analysis showed that an AGR < 1.45 predicted significantly poorer overall and cancer-specific survivals compared to an AGR ≥ 1.45 (P < 0.001 and P = 0.008, respectively). Multivariate analyses showed that an AGR < 1.45 was an independent risk factor for poorer overall and cancer-specific survivals (P = 0.002 and P = 0.015, respectively).
  
  
  CONCLUSIONS
  Preoperative AGR can act as an effective biomarker with easy accessibility for evaluating the prognosis of patients with UTUC. AGR should be applied in UTUC patients for risk stratification and determination of optimal therapeutic regimens.
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Yu
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Li-Qun
authors.initials: LQ
authors.lastname: Zhou
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Zhi-Song
authors.initials: ZS
authors.lastname: He
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Shen
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Qun
authors.initials: Q
authors.lastname: He
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Li-Bo
authors.initials: LB
authors.lastname: Liu
authors.affiliation: Peking University Health Science Center, Beijing, People's Republic of China.
authors.forename: Cong
authors.initials: C
authors.lastname: Wang
authors.affiliation: Peking University Health Science Center, Beijing, People's Republic of China.
authors.forename: Xiao-Yu
authors.initials: XY
authors.lastname: Chen
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Fan
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Shuai
authors.initials: S
authors.lastname: Hu
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Wen-Ke
authors.initials: WK
authors.lastname: Han
authors.affiliation: Department of Urology, Peking University First Hospital, Beijing, People's Republic of China.|Institute of Urology, Peking University, Beijing, People's Republic of China.|National Urological Cancer Center, Beijing, People's Republic of China.
authors.forename: Jie
authors.initials: J
authors.lastname: Jin
mesh_terms: D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D051436:Renal Insufficiency, Chronic / Q000097:blood; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis*; D012712:Serum Globulins / Q000032:analysis*; D014571:Urologic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000401:mortality
chemical_list: D012709:Serum Albumin; D012712:Serum Globulins