Investig Clin Urol.  2021 Sep;62(5):545-552. 10.4111/icu.20210105.

The prognostic value of the pretreatment serum albumin to globulin ratio for predicting adverse pathology in patients undergoing radical prostatectomy for prostate cancer

  • 1Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.
  • 2Department of Urology, Wonkwang University School of Medicine and Hospital, Iksan, Korea
  • 3Department of Urology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
  • 4Department of Urology, Jeonbuk National University Medical School, Jeonju, Korea.
  • 5Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea.
  • 6Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea.
  • 7Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea.


Few studies have demonstrated the clinical significance of pretreatment serum albumin and globulin in prostate cancer (PCa). This study evaluated the association between the pretreatment albumin to globulin ratio (AGR) and clinicopathologic characteristics of nonmetastatic PCa in a large multicenter setting in Korea.
Materials and Methods
This study involved 742 patients with nonmetastatic PCa who underwent radical prostatectomy (RP) in seven institutions between January 2011 and December 2012. The AGR was calculated as follows: albumin/(total protein-albumin). Patients were divided into low and high AGR groups by a cutoff value from a receiver operating characteristic curve analysis.
The best cutoff for the AGR was set at 1.53. The area under the curve of the AGR was 0.624 (95% confidence interval, 0.557–0.671; p<0.001). Patients who had a lower pretreatment AGR (<1.53) were identified as the low AGR group (n=398, 53.6%) and the remaining patients as the high AGR group (n=344, 46.4%). Preoperative AGR was significantly lower in patients with nonorgan-confined disease (≥pT3) than in those with organ-confined disease (≤pT2) (p<0.001). The low AGR group had higher aggressive pathologic Gleason scores (pGS) (≥8) than did the high AGR group (p=0.016). Furthermore, the AGR was an independent prognostic factor for high pGS (≥8) and non-organ-confined disease (≥pT3), according to multivariate logistic regression analysis.
A low AGR was closely associated with nonconfined disease (≥pT3) and high pGS (≥8). AGR can be a useful serological marker for predicting adverse pathology in patients with nonmetastatic PCa who undergo RP.


Albumin; Globulin; Pathology; Prostate cancer; Prostatectomy
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