Decreased Preoperative Serum AGR as a Diagnostic Marker of Poor Prognosis after Radical Surgery of Upper Urinary Tract and Bladder Cancers from a Pooled Analysis of 9,002 Patients

Abstract

A growing number of studies have regarded the preoperative serum albumin-to-globulin ratio (AGR) as a prognostic indicator of urothelial carcinoma (UC) following radical surgery. However, a pooled analysis of AGR’s effect on UC prognosis was still insufficient. Up to January 2022, a systematic search was conducted using PubMed, Embase, Web of Science, and Cochrane Library. Stata SE software was applied in this study. The reviewers collected the hazard ratio (HR) with 95% confidence interval (CI) for overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), progression-free survival (PFS), and metastasis-free survival (MFS). A total of 9,002 patients from 12 retrospective studies were included in this analysis. The results showed that preoperative serum AGR was significantly associated with the OS ( $\text{HR}=1.85$ , $95\%\text{CI}=1.43\text{to}2.39$ ), CSS ( $\text{HR}=2.38$ , $95\%\text{CI}=1.69\text{to}3.34$ ), RFS ( $\text{HR}=1.64$ , $95\%\text{CI}=1.29\text{to}2.08$ ), PFS ( $\text{HR}=2.16$ , $95\%\text{CI}=1.43\text{to}3.27$ ), and MFS ( $\text{HR}=3.00$ , $95\%\text{CI}=1.63\text{to}5.53$ ) of patients with UC following radical surgery. Sensitivity analysis indicated the stability of the results. Subgroup analysis revealed that preoperative low AGR was seen as a risk factor for OS ( $\text{HR}=1.90$ , $95\%\text{CI}=1.34\text{to}2.69$ ), CSS ( $\text{HR}=2.13$ , $95\%\text{CI}=1.40\text{to}3.26$ ), and RFS ( $\text{HR}=1.60$ , $95\%\text{CI}=1.24\text{to}2.07$ ) in upper tract urothelial carcinoma (UTUC), but it was only a risk factor for CSS ( $\text{HR}=2.95$ , $95\%\text{CI}=1.14\text{to}7.60$ ) in bladder cancer (BC). Besides, $\text{preoperative}\text{AGR}\text{cut}-\text{value}\le 1.4$ could not be deemed as a stable prognostic indicator for RFS ( $\text{HR}=2.07$ , $95\%\text{CI}=0.71\text{to}6.04$ ) in UC. However, the predictive ability of $\text{AGR}\text{cut}-\text{value}>1.4$ was stable. All in all, preoperative low AGR was considered as a risk factor for UC. AGR level can be regarded as a prognostic indicator for OS, CSS, and RFS in UTUC but only for CSS in BC. AGR greater than 1.4 can be a great cut-off value for predicting the prognosis of UC patients with radical operation.