.: ORİJİNAL ARAŞTIRMA
The Role of Albumin to Globulin Ratio for Progression in Patients Underwent Active Surveillance for Prostate Cancer: Retrospective Cohort Analyses
Prostat Kanseri Nedeniyle Aktif İzleme Alınan Hastalarda Albumin-Globulin Oranının Progresyondaki Rolü Retrospektif-Kohort Çalışma
J Reconstr Urol. 2025;15(2):31-7
doi: 10.5336/urology.2024-107777
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: In this study, we aimed to show whether albumin/globulin ratio (AGR) can predict progression in prostate cancer (pCA) patients in active surveillance (AS). Material and Methods: A retrospective analysis of data recorded in the electronic registration system of our hospital was conducted for patients who were under AS due to pCA between 2018 and 2022. The inclusion criteria for AS were as follows: prostate specific antigen (PSA)<10 ng/ml, Gleason score≤6, clinical stage T1c-T2a, ≤2 positive cores and ≤50% tumour cells in each positive core. A programme of periodic clinical assessments was implemented for all patients, incorporating digital rectal examination and a PSA test on a quarterly basis for a period of 1 year. Following the conclusion of the initial year, a second biopsy was conducted on all patients. Patients were divided into 2 groups according to their progression status. AGR and other clinicopathological features were then compared between these groups. Results: Receiver operating characteristic analysis was used to determine the optimum AGR cut-off value predicting progression and this value was determined as 1.6. Utilising the 1.6 cut-off point, the sensitivity and specificity of AGR the predictive values for progression were found to be 90% and 62.6%, respectively. The multivariate analysis indicated that low AGR values and the number of cores were more effective in explaining the progression of the disease than the other parameters. Conclussion: We propose that AGR values should be incorporated into AS criteria, in addition to other established criteria.
Keywords: Active surveillance; albumin; globulin; prostate cancer
Objective: In this study, we aimed to show whether albumin/globulin ratio (AGR) can predict progression in prostate cancer (pCA) patients in active surveillance (AS). Material and Methods: A retrospective analysis of data recorded in the electronic registration system of our hospital was conducted for patients who were under AS due to pCA between 2018 and 2022. The inclusion criteria for AS were as follows: prostate specific antigen (PSA)<10 ng/ml, Gleason score≤6, clinical stage T1c-T2a, ≤2 positive cores and ≤50% tumour cells in each positive core. A programme of periodic clinical assessments was implemented for all patients, incorporating digital rectal examination and a PSA test on a quarterly basis for a period of 1 year. Following the conclusion of the initial year, a second biopsy was conducted on all patients. Patients were divided into 2 groups according to their progression status. AGR and other clinicopathological features were then compared between these groups. Results: Receiver operating characteristic analysis was used to determine the optimum AGR cut-off value predicting progression and this value was determined as 1.6. Utilising the 1.6 cut-off point, the sensitivity and specificity of AGR the predictive values for progression were found to be 90% and 62.6%, respectively. The multivariate analysis indicated that low AGR values and the number of cores were more effective in explaining the progression of the disease than the other parameters. Conclussion: We propose that AGR values should be incorporated into AS criteria, in addition to other established criteria.
Keywords: Active surveillance; albumin; globulin; prostate cancer
ÖZET
Amaç: Bu çalışmada, albümin/globulin oranının (AGR) aktif izlemdeki (Aİ) prostat kanseri (PK) hastalarında progresyonu öngörüp öngöremeyeceğini göstermeyi amaçladık. Gereç ve Yöntemler: 2018-2022 yılları arasında PK nedeniyle Aİ altında olan hastalar için hastanemizin elektronik kayıt sistemine kaydedilen verilerin retrospektif analizi yapıldı. Aİ dâhil etme kriterleri prostat spesifik antijen (PSA)<10 ng/ml, gleason skoru ≤6, klinik evre T1c-T2a, ≤2 kor pozitif ve her pozitif korda ≤%50 tümör hücresi olarak belirlendi. Tüm hastalar için 1 yıllık bir süre boyunca 3 ayda 1 dijital rektal muayene ve PSA testini içeren periyodik klinik değerlendirme programı uygulandı. İlk yılın tamamlanmasının ardından, tüm hastalara ikinci bir biyopsi yapıldı. Hastalar progresyon durumlarına göre 2 gruba ayrılmış ve AGR ve diğer klinikopatolojik özellikler gruplar arasında karşılaştırılmıştır. Bulgular: Progresyonu öngören optimal AGR kesme değerini belirlemek için alıcı işletim özelliği analizi kullanılmış ve bu değer 1,6 olarak belirlenmiştir. 1,6 kesme noktası kullanıldığında, AGR'nin progresyon için prediktif değerlerinin duyarlılığı ve özgüllüğü sırasıyla %90 ve %62,6 olarak bulunmuştur. Çok değişkenli analiz, düşük AGR değerlerinin ve kor sayısının hastalığın ilerlemesini açıklamada diğer parametrelere göre daha etkili olduğunu göstermiştir. Sonuç: Mevcut Aİ kriterlerine AGR eklenmesinin yararlı olacağını düşünüyoruz.
Anahtar Kelimeler: Aktif izlem; albümin; globulin; prostat kanseri
Amaç: Bu çalışmada, albümin/globulin oranının (AGR) aktif izlemdeki (Aİ) prostat kanseri (PK) hastalarında progresyonu öngörüp öngöremeyeceğini göstermeyi amaçladık. Gereç ve Yöntemler: 2018-2022 yılları arasında PK nedeniyle Aİ altında olan hastalar için hastanemizin elektronik kayıt sistemine kaydedilen verilerin retrospektif analizi yapıldı. Aİ dâhil etme kriterleri prostat spesifik antijen (PSA)<10 ng/ml, gleason skoru ≤6, klinik evre T1c-T2a, ≤2 kor pozitif ve her pozitif korda ≤%50 tümör hücresi olarak belirlendi. Tüm hastalar için 1 yıllık bir süre boyunca 3 ayda 1 dijital rektal muayene ve PSA testini içeren periyodik klinik değerlendirme programı uygulandı. İlk yılın tamamlanmasının ardından, tüm hastalara ikinci bir biyopsi yapıldı. Hastalar progresyon durumlarına göre 2 gruba ayrılmış ve AGR ve diğer klinikopatolojik özellikler gruplar arasında karşılaştırılmıştır. Bulgular: Progresyonu öngören optimal AGR kesme değerini belirlemek için alıcı işletim özelliği analizi kullanılmış ve bu değer 1,6 olarak belirlenmiştir. 1,6 kesme noktası kullanıldığında, AGR'nin progresyon için prediktif değerlerinin duyarlılığı ve özgüllüğü sırasıyla %90 ve %62,6 olarak bulunmuştur. Çok değişkenli analiz, düşük AGR değerlerinin ve kor sayısının hastalığın ilerlemesini açıklamada diğer parametrelere göre daha etkili olduğunu göstermiştir. Sonuç: Mevcut Aİ kriterlerine AGR eklenmesinin yararlı olacağını düşünüyoruz.
Anahtar Kelimeler: Aktif izlem; albümin; globulin; prostat kanseri
REFERANSLAR:
- Hamidi N, Atmaca AF, Canda AE, Keske M, Ardıçoğlu A. Does extent of prostate-specific antigen fluctuation can predict Gleason score upgrading in low-risk prostate cancer patients? Turk J Urol. 2019;45(Supp. 1):S42-S48. [PubMed] [PMC]
- Boorjian SA, Karnes RJ, Crispen PL, Rangel LJ, Bergstralh EJ, Sebo TJ, et al. The impact of discordance between biopsy and pathological Gleason scores on survival after radical prostatectomy. J Urol. 2009;181(1):95-104; discussion 104. [PubMed]
- Kim HL, Li P, Huang HC, Deheshi S, Marti T, Knudsen B, et al. Validation of the Decipher Test for predicting adverse pathology in candidates for prostate cancer active surveillance. Prostate Cancer Prostatic Dis. 2019;22(3):399-405. [PubMed] [PMC]
- Bastian PJ, Carter BH, Bjartell A, Seitz M, Stanislaus P, Montorsi F, et al. Insignificant prostate cancer and active surveillance: from definition to clinical implications. Eur Urol. 2009;55(6):1321-30. [PubMed]
- Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454(7203):436-44. [PubMed]
- Meyer EJ, Nenke MA, Rankin W, Lewis JG, Torpy DJ. Corticosteroid-binding globulin: a review of basic and clinical advances. Horm Metab Res. 2016;48(6):359-71. [Crossref] [PubMed]
- McMillan DC, Watson WS, O'Gorman P, Preston T, Scott HR, McArdle CS. Albumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss. Nutr Cancer. 2001;39(2):210-3. [PubMed]
- Ku JH, Kim M, Choi WS, Kwak C, Kim HH. Preoperative serum albumin as a prognostic factor in patients with upper urinary tract urothelial carcinoma. Int Braz J Urol. 2014;40(6):753-62. [Crossref] [PubMed]
- Lv GY, An L, Sun XD, Hu YL, Sun DW. Pretreatment albumin to globulin ratio can serve as a prognostic marker in human cancers: a meta-analysis. Clin Chim Acta. 2018;476:81-91. [PubMed]
- Azab B, Kedia S, Shah N, Vonfrolio S, Lu W, Naboush A, et al. The value of the pretreatment albumin/globulin ratio in predicting the long-term survival in colorectal cancer. Int J Colorectal Dis. 2013;28(12):1629-36. [PubMed]
- Azab BN, Bhatt VR, Vonfrolio S, Bachir R, Rubinshteyn V, Alkaied H, et al. Value of the pretreatment albumin to globulin ratio in predicting long-term mortality in breast cancer patients. Am J Surg. 2013;206(5):764-70. [PubMed]
- Du XJ, Tang LL, Mao YP, Sun Y, Zeng MS, Kang TB, Jia WH, Lin AH, Ma J. The pretreatment albumin to globulin ratio has predictive value for long-term mortality in nasopharyngeal carcinoma. PLoS One. 2014;9(4):e94473. [Crossref] [PubMed] [PMC]
- Duran AO, Inanc M, Karaca H, Dogan I, Berk V, Bozkurt O, et al. Albumin-globulin ratio for prediction of long-term mortality in lung adenocarcinoma patients. Asian Pac J Cancer Prev. 2014;15(15):6449-53. [PubMed]
- Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA; Grading Committee. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol. 2016;40(2):244-52. [PubMed]
- Bokhorst LP, Valdagni R, Rannikko A, Kakehi Y, Pickles T, Bangma CH, et al; PRIAS study group. A decade of active surveillance in the PRIAS study: an update and evaluation of the criteria used to recommend a switch to active treatment. Eur Urol. 2016;70(6):954-60. [PubMed]
- Sotomayor PC, Aguilar JC, Mujica K, Zuñiga A, Godoy AS, Smith GJ, et al. Active surveillance in prostate cancer: current and potentially emerging biomarkers for patient selection criteria. Urol Int. 2022;106(12):1201-13. [Crossref] [PubMed]
- Merder E, Ariman A, Bozkurt M, Can O, Abay E, Culha MG, et al. Predictive factors of pathological upgrading in prostate cancer patients treated by radical prostatectomy who are suitable for active surveillance. J Reconstr Urol. 2021;11(3):103-10 [Crossref]
- Song W, Tian C, Wang K, Zhang RJ, Zou SB. Preoperative platelet lymphocyte ratio as independent predictors of prognosis in pancreatic cancer: A systematic review and meta-analysis. PLoS One. 2017;12(6):e0178762. [Crossref] [PubMed] [PMC]
- Chung JW, Park DJ, Chun SY, Choi SH, Lee JN, Kim BS, et al. The prognostic role of preoperative serum albumin/globulin ratio in patients with non-metastatic renal cell carcinoma undergoing partial or radical nephrectomy. Sci Rep. 2020;10(1):11999. [Crossref] [PubMed] [PMC]
- Liu J, Dai Y, Zhou F, Long Z, Li Y, Liu B, et al. The prognostic role of preoperative serum albumin/globulin ratio in patients with bladder urothelial carcinoma undergoing radical cystectomy. Urol Oncol. 2016;34(11):484.e1-484.e8. [Crossref] [PubMed]
- Ye J, Tang C, Wu R, Tang Y, Yin H, Bai Y, et al. Preoperative blood-based nutritional biomarkers as significant prognostic factors after intravesical BCG therapy in patients with non-muscle-invasive bladder cancer. World J Urol. 2024;42(1):428. [Crossref] [PubMed]
- Wang N, Liu JY, Li X, Deng MH, Long Z, Tang J, et al. Pretreatment serum albumin/globulin ratio as a prognostic biomarker in metastatic prostate cancer patients treated with maximal androgen blockade. Asian J Androl. 2019;21(1):56-61. [Crossref] [PubMed] [PMC]
- Quhal F, Pradere B, Sari Motlagh R, Mori K, Laukhtina E, Aydh A, et al. Prognostic value of preoperative albumin to globulin ratio in patients treated with salvage radical prostatectomy for radiation recurrent prostate cancer. Minerva Urol Nephrol. 2021;73(5):610-5. [Crossref] [PubMed]
- Chung JW, Ha YS, Kim SW, Park SC, Kang TW, Jeong YB, et al. The prognostic value of the pretreatment serum albumin to globulin ratio for predicting adverse pathology in patients undergoing radical prostatectomy for prostate cancer. Investig Clin Urol. 2021;62(5):545-52. [Crossref] [PubMed] [PMC]
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