title: Preoperative albumin-to-globulin ratio and prognostic nutrition index predict prognosis for glioblastoma.
abstract: OBJECTIVE
  Impaired immunonutritional status has disadvantageous effects on outcomes for cancer patients. Preoperative albumin-to-globulin ratio (AGR) and the prognostic nutrition index (PNI) have been used as prognostic factors in various cancers. We aimed to evaluate the clinical significance of the AGR and PNI in glioblastoma.
  
  
  METHODS
  This retrospective analysis involved 166 patients. Demographic, clinical, and laboratory data were collected. AGR and the PNI were calculated as AGR = albumin/(total serum protein - albumin) and PNI = albumin (g/L) + 5 × total lymphocyte count (109/L). Overall survival (OS) was estimated by Kaplan-Meier analysis. Receiver-operating characteristic analysis was used to assess the predictive ability of AGR and the PNI. Cox proportional-hazard models estimating hazard ratios (HRs) and 95% confidence intervals (CIs) were used for univariable and multivariable survival analyses.
  
  
  RESULTS
  The cutoff values of AGR and PNI were 1.75 and 48. OS was enhanced, with high AGR (>1.75) and the PNI (>48) (P<0.001 for both). Areas under the receiver-operating characteristic curve for AGR and the PNI were 0.68 and 0.631 for 1-year survival and 0.651 and 0.656 for 2-year survival (P<0.05 for all), respectively. On multivariable analyses, both AGR and the PNI were independent predictors of OS (AGR, HR 0.785, 95% CI 0.357-0.979 [P=0.04]; PNI, HR 0.757, 95% CI 0.378-0.985 [P=0.039]). On subgroup analysis, AGR and the PNI were significant prognostic factors for OS in patients with adjuvant therapy (AGRP<0.001; PNIP=0.001).
  
  
  CONCLUSIONS
  Preoperative AGR and the PNI may be easy-to-perform and inexpensive indices for predicting OS with glioblastoma. AGR and the PNI could also help in developing good adjuvant-therapy schedules.
authors.affiliation: Department of Neurosurgery, Qilu Hospital; Brain Science Research Institute.
authors.forename: Wen-Zhe
authors.initials: WZ
authors.lastname: Xu
authors.affiliation: Department of Neurosurgery, Qilu Hospital; Brain Science Research Institute.
authors.forename: Feng
authors.initials: F
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Qilu Hospital; Brain Science Research Institute.
authors.forename: Zhen-Kuan
authors.initials: ZK
authors.lastname: Xu
authors.affiliation: Department of Radiation Oncology, Qilu Hospital, Shandong University, Jinan, People's Republic of China.
authors.forename: Xuan
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Qilu Hospital; Brain Science Research Institute.
authors.forename: Bin
authors.initials: B
authors.lastname: Sun
authors.affiliation: Department of Neurosurgery, Qilu Hospital; Brain Science Research Institute.
authors.forename: Jing-Wei
authors.initials: JW
authors.lastname: Cao
authors.affiliation: Department of Neurosurgery, Qilu Hospital; Brain Science Research Institute.
authors.forename: Yu-Guang
authors.initials: YG
authors.lastname: Liu
keywords: albumin-to-globulin ratio; glioblastoma; prognosis; prognostic nutrition index