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.