Preoperative albumin-to-globulin ratio and prognostic nutrition index predict prognosis for glioblastoma

Figures & data

Table 1 Clinical characteristics of 166 patients with glioblastoma

Age (years), mean ± SD	50.41±14.5
Median (IQR)	50 (6–83)
Sex (male/female)	84/82
Preoperative BMI, mean ± SD	22.4±3.52
Median (IQR)	22 (15.57–34.38)
KPS
80–100	91 (54.8%)
≤70	75 (45.2%)
Smoking
Never or light	115 (69.3%)
Heavy	51 (30.7%)
Drinking
Never or light	122 (73.5%)
Heavy	44 (26.5%)
Tumor size (cm^3), mean ± SD	52.61±28.12
Median (IQR)	40.1 (6.35–245.52)
Tumor location, region
Frontal	64 (38.6%)
Temporal	56 (33.7%)
Parieto-occipital	34 (20.5%)
Other	12 (7.2%)
Extent of resection
Total	109 (65.7%)
Not total	57 (34.3%)
Preoperative
Albumin level (g/L), mean ± SD	42.21±4.07
Median (IQR)	41.61 (33.91–52.11)
Lymphocyte count (10^9/L), mean ± SD	1.97±0.64
Median (IQR)	1.89 (0.73–3.67)
AGR, mean ± SD	1.65±0.41
Median (IQR)	1.66 (1.19–2.58)
PNI, mean ± SD	51.92±5.23
Median (IQR)	51.1 (41.15–68.95)
Adjuvant radiotherapy	105 (63.3%)
Adjuvant chemotherapy	42 (25.3%)

Note: Data are n (%), unless otherwise indicated.

Abbreviations: SD, standard deviation; IQR, interquartile range; BMI, body mass index; KPS, Karnofsky performance status; AGR, albumin-to-globulin ratio; PNI, prognostic nutrition index.

Table 2 Clinical characteristics of patients by AGR and PNI cutoffs

Characteristics	AGR			PNI
	≤1.75	>1.75	P-value	≤48	>48	P-value
Age, years	50.5±14.94	50.39±11.68	0.958	52.74±14.06	49.29±14.59	0.134
Sex			0.496			0.391
Male	52	33		28	56
Female	51	30		30	52
Preoperative BMI	22.67±3.89	22.1±2.97	0.293	21.58±3.91	22.44±4.04	0.178
KPS			0.335			0.87
80–100	53	38		31	60
≤70	50	25		27	48
Smoking			0.145			0.542
Never or light	69	46		40	75
Heavy	34	17		18	33
Drinking			0.155			0.377
Never or light	79	43		44	78
Heavy	24	20		14	30
Tumor size (cm^3)	54.25±44.37	50.13±37.55	0.528	53.83±36.97	51.92±46.37	0.77
Tumor location			0.522			0.191
Frontal	44	19		27	37
Temporal	33	24		16	40
Parieto-occipital	20	14		9	25
Other	7	5		6	6
Extent of resection			0.108			0.491
Total	63	46		35	74
Not total	40	17		22	35
Preoperative albumin level (g/L)	40.34±3.34	43.20±4.35	<0.001	41.09±3.28	43.69±4.41	<0.001
Preoperative lymphocyte count (10^9/L)	1.91±0.55	2.10±0.61	0.013	1.87±0.46	2.22±0.48	<0.001
Adjuvant radiotherapy			0.192			0.093
No	24	37		34	27
Yes	50	55		46	59
Adjuvant chemotherapy			0.173			0.269
No	80	44		53	71
Yes	23	19		15	27

Note: Data are mean ± SD.

Abbreviations: AGR, albumin-to-globulin ratio; PNI, prognostic nutrition index; BMI, body mass index; KPS, Karnofsky performance status; SD, standard deviation.

Figure 1 Prognosis of preoperative (A) AGR and (B) PNI in survival with glioblastoma.

Abbreviations: AGR, albumin-to-globulin ratio; PNI, prognostic nutrition index.

Figure 2 Predictive value of AGR and PNI for (A) 1-year and (B) 2-year survival. Receiver-operating characteristic curves for AGR and PNI.

Abbreviations: AGR, albumin-to-globulin ratio; PNI, prognostic nutrition index.

Table 3 Prognostic factors for overall survival for 166 patients with glioblastoma

Characteristics	Univariable analysis		P-value	Multivariable analysis		P-value
	HR	95% CI		HR	95% CI
Age (>50 vs ≤50 years)	1.423	1.001–2.145	0.045	1.017	0.996–2.286	0.371
Sex (female vs male)	1.014	0.718–1.434	0.935
Preoperative BMI (>22 vs ≤22 kg/m^2)	1	0.859–1.142	0.993
KPS (80–100 vs ≤70)	0.403	0.257–0.694	0.009	0.528	0.341–0.851	0.032
Smoking (heavy vs never or light)	1.096	0.761–1.577	0.623
Drinking (heavy vs never or light)	0.944	0.645–1.383	0.769
Tumor size (>40 vs ≤40 cm^3)	1.769	1.41–2.198	0.022	1.343	1.014–1.726	0.037
Tumor location
Frontal		1	Ref
Temporal	1.153	0.804–1.656	0.49
Parieto-occipital	0.761	0.44–1.237	0.271
Other	1.294	0.713–2.476	0.363
Extent of resection (total vs not total)	0.315	0.244–0.762	0.017	0.416	0.334–0.885	0.026
Preoperative albumin level (>42 vs ≤42 g/L)	0.617	0.374–0.812	0.035	0.918	0.571–1.389	0.359
Preoperative lymphocyte count (>1.9 vs ≤1.9×10^9/L)	0.578	0.379–0.961	0.028	0.84	0.541–1.225	0.196
AGR (>1.75 vs ≤1.75)	0.456	0.244–0.608	0.003	0.785	0.357–0.979	0.04
PNI (>48 vs ≤48)	0.372	0.245–0.565	<0.001	0.757	0.378–0.985	0.039
Adjuvant radiotherapy (yes vs no)	0.554	0.402–0.721	0.004	0.599	0.320–0.983	0.031
Adjuvant chemotherapy (yes vs no)	0.542	0.357–0.822	0.002	0.866	0.494–1.298	0.226

Abbreviations: HR, hazard ratio; CI, confidence interval; BMI, body mass index; KPS, Karnofsky performance status; AGR, albumin-to-globulin ratio; PNI, prognostic nutrition index.

Figure 3 Subgroup analyses of the prognostic impact of (A) AGR and (B) PNI for patients with adjuvant therapy by Kaplan–Meier survival curves.

Abbreviations: AGR, albumin-to-globulin ratio; PNI, prognostic nutrition index.