Pretreatment albumin-to-globulin ratio as a predictive marker for tyrosine kinase inhibitor in non-small cell lung cancer

Article type: Research Article

Authors: Park, Sehhoon^a | Park, Seongyeol^a | Lee, Se-Hoon^{a; c; *} | Suh, Beomseok^b | Ock, Chan-Young^a | Keam, Bhumsuk^a | Kim, Tae Min^a | Kim, Dong-Wan^a | Kim, Young Whan^a | Heo, Dae Seog^a

Affiliations: [a] Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea | [b] Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Korea | [c] Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence: [*] Corresponding author: Se-Hoon Lee, Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea. Tel.: +82 2 3410 1132; E-mail:sehoon.lee119@gmail.com

Abstract: BACKGROUND: A low albumin-to-globulin ratio (AGR) has been known as a prognostic factor for cancer-related mortality. However, no study has elucidated its usefulness as a predictive factor in the era of targeted therapy, and so, we evaluated this in the present study. METHODS: We retrospectively analyzed 2012 non-small cell lung cancer (NSCLC) patients treated with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs). Among these patients, 645 patients who had EGFR mutation and suitable pretreatment laboratory values were included. AGR was calculated 2 months before treatment and 4 months after treatment in each patient. The optimal cutoff value of AGR, and progression free survival (PFS) were also determined. RESULTS: The optimal cutoff value of AGR was 1.17, which yielded a highest HR of 1.89 (P< 0.001) for poor PFS. The median PFS was 9.5 months (95% confidential interval [CI] 7.0-10.4) in patients with pretreatment AGR < 1.17 and 13.5 months (95% CI 11.9-14.7) in those with pretreatment AGR ≥ 1.17. Pretreatment AGR showed an independent predictive value (adjusted HR 1.80, P < 0.001) when age, performance status, and pre-TKI systemic treatment was adjusted for. CONCLUSIONS: We suggest that patients with NSCLC with EGFR mutations who have AGR values lower than 1.17 at the beginning of EGFR TKI treatment should be considered to have a high risk of early EGFR TKI failure.

Keywords: Albumins, globulins, non-small-cell lung carcinoma, tyrosine kinases inhibitor, epidermal growth factor receptor, disease-free survival

DOI: 10.3233/CBM-160581

Journal: Cancer Biomarkers, vol. 16, no. 3, pp. 425-433, 2016