J Cancer 2017; 8(2):258-265. doi:10.7150/jca.16525

Research Paper

Preoperative Albumin to Globulin Ratio (AGR) as Prognostic Factor in Renal Cell Carcinoma

Xiaobo He1,2*, Shengjie Guo1*, Dong Chen1*, Guangwei Yang2, Xin Chen1, Yijun Zhang3, Qiuming He1, Zike Qin1, Zhuowei Liu1, Yunfei Xue4, Meng Zhang4, Ruiwu Liu5, Fangjian Zhou1, Hui Han1, Kai Yao1✉

1. Department of Urology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
2. Department of Medical Oncology, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
3. Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
4. Medicine school of Sun Yat-Sen University, Guangzhou, China
5. Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, California, United States of America
* These authors contributed equally to this work.


Background: Malnutrition and systemic inflammatory response are frequently associated with prognosis in patients with several types of cancer, including renal cell carcinoma (RCC). The study is aimed to investigate the ability of preoperative serum albumin to globulin ratio (AGR) to predict the long-term mortality of RCC patients.

Methods: The study is a retrospective study of an unselected cohort of 895 RCC patients who underwent a curative radical or partial nephrectomy at the Department of Urology in the Sun Yat-Sen University Cancer Center between January 2000 and December 2012 and had documented preoperative serum total protein and albumin (ALB) levels. The preoperative AGR was calculated as the ratio of ALB to (total protein-ALB) and its association with other clinical indices was assessed using survival analysis.

Results: Low preoperative AGR was associated with older population, lower hemoglobin, higher total protein, lower ALB, lower body mass index and advanced stage. The univariate and multivariate Cox analyses demonstrated that preoperative AGR was an independent prognostic indicator of overall survival (OS) (hazard ratio (HR): 0.63, 95% confidence interval (CI): 0.43 to 0.93, P=0.022). In addition, patients with low preoperative AGR at pT1-2, pT3-4, pN0, pN1, pM0 and pM1 stages had significantly shorter OS than patients with high preoperative AGR.

Conclusion: Preoperative AGR is a proven objective, reproducible, inexpensive survival predictor of RCC patients following surgical resection and should be considered for routine clinical use.

Keywords: Renal Cell Carcinoma, Albumin, Total Protein, Albumin to Globulin ratio.

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How to cite this article:
He X, Guo S, Chen D, Yang G, Chen X, Zhang Y, He Q, Qin Z, Liu Z, Xue Y, Zhang M, Liu R, Zhou F, Han H, Yao K. Preoperative Albumin to Globulin Ratio (AGR) as Prognostic Factor in Renal Cell Carcinoma. J Cancer 2017; 8(2):258-265. doi:10.7150/jca.16525. Available from http://www.jcancer.org/v08p0258.htm