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

Authors Xu WZ, Li F, Xu ZK, Chen X, Sun B, Cao JW, Liu YG

Received 11 November 2016

Accepted for publication 7 January 2017

Published 8 February 2017 Volume 2017:10 Pages 725—733


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Samir Farghaly

Wen-Zhe Xu,1,2 Feng Li,1,2 Zhen-Kuan Xu,1,2 Xuan Chen,3 Bin Sun,1,2 Jing-Wei Cao,1,2 Yu-Guang Liu1,2

1Department of Neurosurgery, Qilu Hospital, 2Brain Science Research Institute, 3Department of Radiation Oncology, Qilu Hospital, Shandong University, Jinan, People’s Republic of China

Objective: Impaired immunonutritional status has disadvantageous effects on outcomes for cancer patients. Preoperative albumin-to-globulin ratio (AGR) and the prognostic nutrition index (PNI) have been used as prognostic factors in various cancers. We aimed to evaluate the clinical significance of the AGR and PNI in glioblastoma.
Materials and methods: This retrospective analysis involved 166 patients. Demographic, clinical, and laboratory data were collected. AGR and the PNI were calculated as AGR = albumin/(total serum protein – albumin) and PNI = albumin (g/L) + 5 × total lymphocyte count (109/L). Overall survival (OS) was estimated by Kaplan–Meier analysis. Receiver-operating characteristic analysis was used to assess the predictive ability of AGR and the PNI. Cox proportional-hazard models estimating hazard ratios (HRs) and 95% confidence intervals (CIs) were used for univariable and multivariable survival analyses.
Results: The cutoff values of AGR and PNI were 1.75 and 48. OS was enhanced, with high AGR (>1.75) and the PNI (>48) (P<0.001 for both). Areas under the receiver-operating characteristic curve for AGR and the PNI were 0.68 and 0.631 for 1-year survival and 0.651 and 0.656 for 2-year survival (P<0.05 for all), respectively. On multivariable analyses, both AGR and the PNI were independent predictors of OS (AGR, HR 0.785, 95% CI 0.357–0.979 [P=0.04]; PNI, HR 0.757, 95% CI 0.378–0.985 [P=0.039]). On subgroup analysis, AGR and the PNI were significant prognostic factors for OS in patients with adjuvant therapy (AGR P<0.001; PNI P=0.001).
Conclusion: Preoperative AGR and the PNI may be easy-to-perform and inexpensive indices for predicting OS with glioblastoma. AGR and the PNI could also help in developing good adjuvant-therapy schedules.

Keywords: glioblastoma, albumin-to-globulin ratio, prognostic nutrition index, prognosis

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