Albumin-Globulin Ratio Predicts Bladder Cancer Survival

The pretreatment albumin-globulin ratio can independently predict survival outcomes in patients with urothelial carcinoma, according to a recent meta-analysis.

Zhongyou Xia of the Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College, and colleagues conducted the analysis and published its results in Frontiers in Oncology.

The albumin-globulin ratio is a “noninvasive, inexpensive, and easily accessible prognostic biomarker” that can be of “great significance in guiding the individual treatment of patients” with urothelial carcinoma, the researchers wrote.

The investigators searched PubMed, Web of Science, China National Knowledge Infrastructure, Google Scholar, and Cochrane Library for relevant papers through May 2022. They identified 12 studies including 5727 patients.

A lower albumin-globulin ratio before treatment was significantly associated with lower overall survival (OS) (hazard ratio [HR], 1.99; 95% CI, 1.45-2.75; P<.001), lower cancer-specific survival (HR, 2.01; 95% CI, 1.50-2.69; P<.001), and lower recurrence-free survival (RFS) (HR, 1.39; 95% CI, 1.12-1.72; P=.002) in patients with urothelial carcinoma.

The albumin-globulin ratio remained predictive of OS and cancer-specific survival when stratified by cancer type. Lower albumin-globulin ratios were significantly associated with lower OS (HR, 1.63; 95% CI, 1.24-2.13; P<.001) and lower cancer-specific survival (HR, 1.86; 95% CI, 1.31-2.64; P=.001) in patients with upper tract urothelial carcinoma. In patients with bladder cancer, lower albumin-globulin ratios were also associated with lower OS (HR, 10.42; 95% CI, 3.02-35.71; P<.001) and lower cancer-specific survival (HR, 2.48; 95% CI, 1.47-4.16; P=.001).

When researchers stratified patients by cancer stage, a low albumin-globulin ratio only predicted outcomes of patients with non-metastatic urothelial carcinoma. A lower albumin-globulin ratio was significantly associated with a lower OS (HR, 1.86; 95% CI, 1.35-2.57; P<.001) and lower cancer-specific survival (HR, 1.81; 95% CI, 1.46-2.75; P<.001) in these patients.

“This meta-analysis reveals that the pretreatment [albumin-globulin ratio] is an independent prognostic indicator for patients with [urothelial carcinoma], especially for non-metastatic [urothelial carcinoma] patients,” the researchers concluded. “Low [albumin-globulin ratio] is related to worse OS, [cancer-specific survival], and RFS. However, future studies with larger sample sizes and randomized controlled trials are needed to confirm this conclusion.”

Xia Z, Fu X, Li J, et al. Prognostic value of pretreatment serum albumin-globulin ratio in urothelial carcinoma: a systematic review and meta-analysis. Front Oncol. 2022. doi:10.3389/fonc.2022.992118