Pretreatment albumin to globulin ratio can serve as a prognostic marker in human cancers: a meta-analysis

Purpose: Our meta-analysis aims to investigate the prognostic role of pretreatment albumin to globulin ratio (AGR) in human cancers. Methods: Available databases were searched up to Sept 25th, 2017. Pooled hazard ratios (HRs) and risk ratio (RRs) with their corresponding 95% confidence intervals (CIs) were used to assess the prognostic impact of AGR on overall survival (OS)/disease-free survival (DFS)/progression-free survival (PFS) and 5-year mortality respectively. Results: Totally, 28 studies with 15 356 cancer patients were included. Our results demonstrated that low pretreatment AGR is associated with poor OS (HR = 2.08, 95%CI:1.78-2.44, univariate results; HR = 1.75, 95%CI:1.56-1.97, multivariate results), poor DFS (HR = 1.96, 95%CI:1.48-2.59, univariate results; HR = 1.64, 95%CI:1.26-2.14, multivariate results) and poor PFS (HR = 1.89, 95%CI:1.61-2.22, univariate results; HR = 1.66, 95%CI:1.32-2.0, multivariate results). Meanwhile, low pretreatment AGR is also associated with increased 5-year mortality (RR = 2.12, 95%CI:1.48-3.03). Moreover, this significant correlation was not altered by stratified analysis according to publication times, sample sizes, patient origins, AGR cutoff values, cancer systems, treatment methods or HR sources. Conclusion: Low pretreatment AGR is associated with poor prognosis in human cancers, and AGR should be used as a prognostic marker during cancer therapy.