Published online May 15, 2022. doi: 10.4251/wjgo.v14.i5.1002
Peer-review started: November 9, 2021
First decision: December 12, 2021
Revised: December 26, 2021
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: May 15, 2022
Processing time: 182 Days and 4.7 Hours
Previous studies have suggested that a low albumin-to-alkaline phosphatase ratio (AAPR) is associated with a lower survival rate in patients with various malignancies. However, the relationship between pretreatment AAPR and the prognosis of patients with gastric cancer (GC) remains unclear.
To investigate the prognostic value of AAPR in distant metastatic GC.
A total of 191 patients with distant metastatic cancer from a single institute were enrolled in this study. Pretreatment clinical data, including serum albumin and alkaline phosphatase levels, were collected. A chi-square test or Fisher’s exact test was applied to evaluate the correlations between AAPR and various clinical parameters in GC patients. The Kaplan–Meier method and Cox proportional hazards regression model were used to evaluate the prognostic efficacy of AAPR in metastatic GC patients. A two-sided P value lower than 0.05 was considered statistically significant.
A receiver operating characteristic curve indicated that 0.48 was the optimal threshold value for AAPR. AAPR ≤ 0.48 was significantly associated with bone (P < 0.05) and liver metastasis (P < 0.05). Patients with high levels of AAPR had better survival in terms of overall survival (OS) and progression-free survival (PFS), regardless of the presence of liver/bone metastasis. Pretreatment AAPR was found to be a favorable predictor of OS and PFS based on a multivariate cox regression model. AAPR-M system, constructed based on AAPR and number of metastatic sites, showed superior predictive ability relative to the number of metastatic sites for predicting survival.
Pretreatment AAPR may serve as an independent prognostic factor for predicting PFS and OS in patients with metastatic GC. Furthermore, AAPR may assist clinicians with individualizing treatment.
Core Tip: Previous studies have suggested that a low albumin-to-alkaline phosphatase ratio (AAPR) is associated with inferior survival in patients with various malignancies. However, the relationship between pretreatment AAPR and the prognosis of patients with gastric cancer (GC) remains unclear. In this study, we showed that pretreatment AAPR was a favorable predictor of overall survival (OS) and progression-free survival (PFS) by the multivariate cox regression model with hazard ratios of 0.476 and 0.527, respectively. Pretreatment AAPR may serve as an independent prognostic factor for predicting PFS and OS in patients with metastatic cancer. Furthermore, AAPR may assist clinicians with individualizing treatment.