Hypoalbuminemia in colorectal cancer prognosis: Nutritional marker or inflammatory surrogate?

Table 2 Pretreatment albumin-to-globulin ratio and colorectal cancer

Ref.	Design	Objective	Sample size	Findings	Comments
Azab et al[43]	Retrospective cohort study	AGR's prognostic value in CRC-related mortality	534 patients	75% lower 4-yr mortality in high AGR (> 1.32) compared to low AGR tertile (< 1.03), independent of ALB	Study excluded patients who received preoperative chemotherapy
Shibutani et al[44]	Retrospective cohort study	AGR's prognostic value in unresectable metastatic CRC treated with palliative chemotherapy	66 patients	High AGR group had higher OS (HR = 2.25, P = 0.03) and PFS (HR = 2.66, P = 0.03) than low AGR group on multivariate analysis	No statistically significant difference in ORR between high and low AGR groups
Suh et al[45]	Retrospective cohort study	Relationship between AGR and cancer incidence among healthy adults	26974 adults (30 ≤ age ≤ 80)	Low AGR (< 1.1) had higher cancer incidence, an OR = 3.28 for CRC development and higher cancer mortality compared to AGR > 1.1	First report on association of low AGR with the risk of cancer incidence and mortality in healthy adults

AGR: Serum albumin-to-globulin ratio; ALB: Serum albumin; CRC: Colorectal cancer; OS: Overall survival; PFS: Progression-free survival; OR: Odds ratio; ORR: Overall response rate.