PURPOSE: To evaluate the potential predictive value of the preoperative serum albumin to globulin ratio (AGR) for oncological outcomes in patients treated with radical prostatectomy (RP) for clinically non-metastatic prostate cancer (PCa). METHODS: Pre-operative AGR was assessed in a multi-institutional cohort of 6041 patients treated with RP. Logistic regression analyses were performed to assess the association of the AGR with advanced disease. We performed Cox regression analyses to determine the relationship between AGR and biochemical recurrence (BCR). RESULTS: The optimal cut-off value was determined to be 1.31 according to receiver operating curve analysis. Compared to patients with a higher AGR, those with a lower preoperative AGR had worse BCR-free survival (P < 0.01) in the Kaplan-Meier analysis. Pre- and post-operative multivariable models that adjusted for the effects of established clinicopathologic features, confirmed its independent association with BCR [hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.31-1.75, P < 0.01, HR 1.55, 95% CI 1.34-1.79, P < 0.01, respectively]. However, the addition of AGR to established prognostic models did not improve their discrimination. CONCLUSION: While AGR is significantly associated with BCR, in the present study, the clinical impact of AGR was not large enough to affect patient management. Longer follow-up is necessary to observe the true effect of AGR.

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Canada

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology Comprehensive Cancer Center Vienna General Hospital Medical University of Vienna Währinger Gürtel 18 20 1090 Vienna Austria

Department of Urology IRCCS European Institute of Oncology Milan Italy

Department of Urology Jikei University School of Medicine Tokyo Japan

Department of Urology King Fahad Specialist Hospital Dammam Saudi Arabia

Department of Urology King Faisal Medical City Abha Saudi Arabia

Department of Urology Shariati Hospital Tehran University of Medical Sciences Teheran Iran

Department of Urology University Hospital of Tours Tours France

Department of Urology University of Texas Southwestern Dallas TX USA

Departments of Urology Weill Cornell Medical College New York NY USA

Division of Oncology Unit of Urology URI IRCCS Ospedale San Raffaele Milan Italy

Division of Urological Surgery Brigham and Women's Hospital Harvard Medical School Boston MA USA

Division of Urology Department of Special Surgery Jordan University Hospital The University of Jordan Amman Jordan

European Association of Urology Research Foundation Arnhem Netherlands

Institute for Urology and Reproductive Health Sechenov University Moscow Russia

Karl Landsteiner Institute Vienna Austria

Martini Klinik Prostate Cancer Center Department of Urology University Hospital Hamburg Eppendorf Hamburg Germany

Research Center for Evidence Based Medicine Tabriz University of Medical Sciences Tabriz Iran

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Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7–30. doi: 10.3322/caac.21590. PubMed DOI

Walz J, et al. Clinicians are poor raters of life-expectancy before radical prostatectomy or definitive radiotherapy for localized prostate cancer. BJU Int. 2007;100(6):1254–1258. doi: 10.1111/j.1464-410X.2007.07130.x. PubMed DOI

Lughezzani G, et al. Predictive and prognostic models in radical prostatectomy candidates: a critical analysis of the literature. Eur Urol. 2010;58(5):687–700. doi: 10.1016/j.eururo.2010.07.034. PubMed DOI PMC

Gallina A, et al. Comparison of stage migration patterns between Europe and the USA: an analysis of 11 350 men treated with radical prostatectomy for prostate cancer. BJU Int. 2008;101(12):1513–1518. doi: 10.1111/j.1464-410X.2008.07519.x. PubMed DOI

Shariat SF, et al. Critical review of prostate cancer predictive tools. Future Oncol. 2009;5(10):1555–1584. doi: 10.2217/fon.09.121. PubMed DOI PMC

Shariat SF, et al. Tumor markers in prostate cancer I: blood-based markers. Acta Oncol. 2011;50 Suppl(Suppl 1):61–75. doi: 10.3109/0284186X.2010.542174. PubMed DOI PMC

Karam JA, et al. Caveolin-1 overexpression is associated with aggressive prostate cancer recurrence. Prostate. 2007;67(6):614–622. doi: 10.1002/pros.20557. PubMed DOI

Chun FK, et al. Significant upgrading affects a third of men diagnosed with prostate cancer: predictive nomogram and internal validation. BJU Int. 2006;98(2):329–334. doi: 10.1111/j.1464-410X.2006.06262.x. PubMed DOI

Shariat SF, et al. Association of pre-operative plasma levels of vascular endothelial growth factor and soluble vascular cell adhesion molecule-1 with lymph node status and biochemical progression after radical prostatectomy. J Clin Oncol. 2004;22(9):1655–1663. doi: 10.1200/JCO.2004.09.142. PubMed DOI

Bensalah K, Montorsi F, Shariat SF. Challenges of cancer biomarker profiling. Eur Urol. 2007;52(6):1601–1609. doi: 10.1016/j.eururo.2007.09.036. PubMed DOI

Shariat SF, et al. Statistical consideration for clinical biomarker research in bladder cancer. Urol Oncol. 2010;28(4):389–400. doi: 10.1016/j.urolonc.2010.02.011. PubMed DOI PMC

Shariat SF, et al. Improved prediction of disease relapse after radical prostatectomy through a panel of pre-operative blood-based biomarkers. Clin Cancer Res. 2008;14(12):3785–3791. doi: 10.1158/1078-0432.CCR-07-4969. PubMed DOI

Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999;340(6):448–454. doi: 10.1056/NEJM199902113400607. PubMed DOI

Du XJ, et al. The pretreatment albumin to globulin ratio has predictive value for long-term mortality in nasopharyngeal carcinoma. PLoS ONE. 2014;9(4):e94473. doi: 10.1371/journal.pone.0094473. PubMed DOI PMC

Li J, et al. Prognostic value of pretreatment albumin to globulin ratio in lung cancer: a meta-analysis. Nutr Cancer. 2020;73:1–8. doi: 10.1080/01635581.2020.1820055. PubMed DOI

Shibutani M, et al. The pretreatment albumin to globulin ratio predicts chemotherapeutic outcomes in patients with unresectable metastatic colorectal cancer. BMC Cancer. 2015;15:347. doi: 10.1186/s12885-015-1375-x. PubMed DOI PMC

Shariat SF, et al. Lymphovascular invasion is a pathological feature of biologically aggressive disease in patients treated with radical prostatectomy. J Urol. 2004;171(3):1122–1127. doi: 10.1097/01.ju.0000113249.82533.28. PubMed DOI

Stephenson AJ, et al. Defining biochemical recurrence of prostate cancer after radical prostatectomy: a proposal for a standardized definition. J Clin Oncol. 2006;24(24):3973–3978. doi: 10.1200/JCO.2005.04.0756. PubMed DOI

Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3(1):32–35. doi: 10.1002/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3. PubMed DOI

European Association, U . European association of urology guidelines. 2020 edition. Vol. presented at the EAU annual congress Amsterdam 2020. Arnhem, The Netherlands: European Association of Urology Guidelines Office; 2020.

Azab B, 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):1629–1636. doi: 10.1007/s00384-013-1748-z. PubMed DOI

Mao M-J, et al. Clinical significance of pre-operative albumin and globulin ratio in patients with gastric cancer undergoing treatment. Biomed Res Int. 2017;2017:3083267–3083267. PubMed PMC

Duran AO, et al. Albumin-globulin ratio for prediction of long-term mortality in lung adenocarcinoma patients. Asian Pac J Cancer Prev: APJCP. 2014;15(15):6449–6453. doi: 10.7314/APJCP.2014.15.15.6449. PubMed DOI

Azab BN, 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):764–770. doi: 10.1016/j.amjsurg.2013.03.007. PubMed DOI

Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420(6917):860–867. doi: 10.1038/nature01322. PubMed DOI PMC

Wang N, et al. Pretreatment serum albumin/globulin ratio as a prognostic biomarker in metastatic prostate cancer patients treated with maximal androgen blockade. Asian J Androl. 2018;21:56. PubMed PMC