Preoperative albumin-to-globulin ratio as a significant prognostic indicator in urologic cancers: a meta-analysis

Figures & data

Table 1 Main characteristics of eligible studies in the meta-analysis

Study, year	Disease type	Country	Study type	Included period	No. of cases	Male/ female	Age (years)	Survival type	Cutoff value	Cutoff selection	Follow- up	MVA	NOS score
Zhang et al 2015^Citation24	UTCC	China	R	2006–2008	187	85/102	median: 70	OS, CSS	1.45	ROC	≥5 years	yes	7
Liu et al 2016^Citation25	BC	China	R	2000–2013	296	250/46	mean: 61.71	CSS, RFS	1.6	ROC	≥5 years	yes	7
He et al 2017^Citation33	RCC	China	R	2000–2012	895	600/295	mean: 51.44	OS	1.47	ROC	≥5 years	yes	8
Liu et al 2017^Citation26	BC	China	R	2009–2013	189	165/24	NA	OS, PFS, CSS	1.55	ROC	≥5 years	yes	7
Koparal et al 2018^Citation23	RCC	Turkey	R	2010–2016	162	102/60	mean:56.5	OS, DFS	1.4	ROC	≥5 years	yes	6
Niwa et al 2018^Citation32	BC	China	R	2000–2015	364	294/70	median: 71	RFS, PFS	1.6	NA	≥5 years	yes	8
Shang et al 2018^Citation34	BC	China	R	2004–2011	470	354/188	median: 70	OS, CSS	1.68	ROC	≥5 years	yes	8
Fukushima et al 2018^Citation31	UTCC	Japan	R	2003–2016	105	74/31	median: 74	OS, DFS	1.24	ROC	≥5 years	yes	6

Abbreviations: BC, bladder carcinoma; CSS, cancer-specific survival; DFS, disease-free survival; MVA, multivariate analysis; NA, not available; NOS, Newcastle–Ottawa Scale; OS, overall survival; PFS, progression-free survival; R, retrospectively; RCC, renal cell carcinoma; RFS, recurrence-free survival; ROC, receiver operating characteristic curve; UTCC, upper tract urothelial carcinoma

Figure 1 Flow diagram of the meta-analysis.

Figure 2 Meta-analysis of the relationship between AGR and OS.

Abbreviations: AGR, albumin-to-globulin ratio; BC, bladder carcinoma; OS, overall survival; RCC, renal cell carcinoma; UTCC, upper tract urothelial carcinoma.

Table 2 Subgroup analysis of the association between AGR and OS

Subgroup factor	Divided standard	No. of studies	Pooled HR (95% CI)	P-value	Heterogeneity
					I^2 (%)	Phet
Cancer type	UTCC^Citation24,Citation31	2	0.37 (0.18–0.56)	<0.001	14.5	0.279
	RCC^Citation23,Citation33	2	0.63 (0.38–0.88)	<0.001	0.0	0.970
	BC^Citation26,Citation34	2	0.30 (0.16–0.44)	<0.001	55.9	0.132
Sample size	≥300^Citation33,Citation34	2	0.51 (0.35–0.67)	<0.001	36.8	0.208
	<300^Citation23,Citation24,Citation26,Citation31	4	0.29 (0.16–0.42)	<0.001	0.0	0.445
Cutoff value	≥1.47^Citation26,Citation33,Citation34	3	0.38 (0.26–0.50)	<0.001	72.6	0.026
	<1.47^Citation23,Citation24,Citation31	3	0.37 (0.18–0.56)	<0.001	0.0	0.551

Abbreviations: BC, bladder carcinoma; RCC, renal cell carcinoma; UTCC, upper tract urothelial carcinoma.

Figure 3 Meta-analysis of the relationship between AGR and CSS.

Abbreviations: AGR, albumin-to-globulin ratio; BC, bladder carcinoma; CSS, cancer-specific survival; UTCC, upper tract urothelial carcinoma.

Figure 4 Meta-analysis of the relationship between AGR and EFS.

Abbreviations: AGR, albumin-to-globulin ratio; DFS, disease-free survival; EFS, event-free survival; PFS, progression-free survival; RFS, recurrence-free survival.

Figure 5 Meta-analysis of the association between AGR and tumor grade.

Abbreviation: AGR, albumin-to-globulin ratio.

Figure 6 Meta-analysis of the association between AGR and lymphovascular invasion.

Abbreviation: AGR, albumin-to-globulin ratio.

Figure 7 Meta-analysis of the association between AGR and pT status.

Abbreviation: AGR, albumin-to-globulin ratio.

Figure 8 Meta-analysis of the association between AGR and pN status.

Abbreviation: AGR, albumin-to-globulin ratio.

Figure 9 Publication bias assessment for OS (A), CSS (B), EFS (C), tumor grade (D), LVI (E), pT (F) and pN (G).

Abbreviations: CSS, cancer-specific survival; EFS, event-free survival; LVI, lymphovascular invasion; OS, overall survival.

Figure 10 Sensitivity analysis for OS (A), CSS (B), EFS (C), tumor grade (D), LVI (E), pT (F) and pN (G).

Abbreviations: CSS, cancer-specific survival; EFS, event-free survival; LVI, lymphovascular invasion; OS, overall survival.

Table S1 Relevant data for AGR and clinicopathologic features

Tumor grade
	High grade		Low grade
Study	Low AGR	High AGR	Low AGR	High AGR
Fukushima et al 2018^Citation1	31	22	15	37
He et al 2017^Citation2	166	195	205	329
Koparal et al 2018^Citation3	32	29	37	64
Liu et al 2016^Citation4	35	40	119	102
Niwa et al 2018^Citation5	53	96	59	156
Zhang et al 2015^Citation6	5	37	73	72
Lymphovascular invasion
	Low AGR		High AGR
Study	yes (+)	no (−)	yes (+)	no (−)
Fukushima et al 2018^Citation1	26	20	15	44
Liu et al 2017^Citation7	40	70	16	63
Zhang et al 2015^Citation6	13	65	15	94
pT status
	pT3/4		pTa-2
Study	Low AGR	High AGR	Low AGR	High AGR
Fukushima et al 2018^Citation1	25	9	21	50
He et al 2017^Citation2	83	35	288	489
Koparal et al 2018^Citation3	18	10	51	83
Liu et al 2016^Citation4	69	33	85	109
Liu et al 2017^Citation7	42	27	68	52
Zhang et al 2015^Citation6	21	19	57	90
pN status
	Low AGR		High AGR
Study	Positive (+)	Negative (−)	Positive (+)	Negative (−)
Fukushima et al 2018^Citation1	1	45	1	58
He et al 2017^Citation2	47	324	19	505
Liu et al 2016^Citation4	49	105	14	128
Liu et al 2017^Citation7	24	86	9	70
Zhang et al 2015^Citation6	5	73	3	106

Abbreviation: AGR, albumin-to-globulin ratio.

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 PubMed Web of Science ®Google Scholar

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 PubMed Web of Science ®Google Scholar

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 PubMed Web of Science ®Google Scholar

NiwaNMatsumotoKIdeHNagataHOyaMPrognostic value of pretreatment Albumin-to-Globulin ratio in patients with non-muscle-invasive bladder cancerClin Genitourin Cancer2018163e655e66129366633

 PubMed Web of Science ®Google Scholar

ZhangBYuWZhouLQPrognostic significance of preoperative albumin-globulin ratio in patients with upper tract urothelial carcinomaPLoS One20151012e014496126681341

 PubMed Web of Science ®Google Scholar

LiuZHuangHLiSThe prognostic value of preoperative serum albumin-globulin ratio for high-grade bladder urothelial carcinoma treated with radical cystectomy: A propensity score-matched analysisJ Cancer Res Ther201713583784329237914

 PubMed Web of Science ®Google Scholar