Overall, Progression-Free Survival in Colon Cancer Indicated Through Visceral Proteins

Lower albumin-globulin ratio (AGR), prealbumin-globulin ratio (PGR), and albumin-prealbumin-globulin ratio (APGR) were correlated with overall survival (OS) and progression-free survival (PFS) in patients with colon cancer, according to a study published in Heliyon.¹

CRC is the second leading cause of cancer deaths worldwide,² with incidences rising in patients 45 years and older. Colon cancer is the most common form of CRC, but it is often hard to diagnosis early because its symptoms are less obvious. Identifying prognostic factors can help in increasing the 5-year survival of patients with CRC. Albumin, globulin, and prealbumin are visceral proteins that are part of many pathological functions. This study aimed to assess different combinations of these proteins to determine their roles in stratification and decision-making in CRC.

Patients who underwent resection for CRC at the First Affiliated Hospital of Guangxi Medical University were included if they had complete serological test data available, complete clinicopathologic data available, and a primary cancer cite of the colon and underwent radical surgery. Patients were excluded if they had severe liver and kidney dysfunction, had an unclear primary tumor site, had received neoadjuvant chemoradiotherapy, or were lost to follow-up.

Visceral proteins can be predictors of colon cancer prognosis, according to a new study | Image credit: Sebastian Kaulitzki - stock.adobe.com

All demographic data were collected from the patients, along with tumor pathological data, which included location, diameter, pathological type, and differentiation of the tumor. All patients had blood samples collected prior to their surgery to assess the visceral protein ratios: AGR, PGR, and APGR. Telephone consultations and outpatient examinations were used as the main methods of follow-up with a patient.

There were 705 patients diagnosed with colon cancer who were included in this study, with the mean (SD) age being 58.1 (13) years and 62.8% of whom were men. A total of 48.7% had tumor, node, metastatis stage III/IV disease; 25.8% had a recurrence of colon cancer; 39.7% died. The median levels of albumin, globulin, and prealbumin were 38.0 (95% CI, 35.1-40.8), 26.4 (95% CI, 23.6-29.6), and 188.7 (95% CI, 145.3-232.6), respectively.

The median AGR was 1.43 (95% CI, 1.24-1.62) overall, with the median slightly lower in patients who experienced recurrence compared with those who did not (1.37 vs 1.45) and in patients who died compared with those who did not (1.37 vs 1.49). The median PGR was 7.22 (95% CI, 5.23-9.13), and these values were lower in patients who had recurrence (6.53 vs 7.46) and those who died (6.33-7.78) compared with those who didn’t. The APGR median value was 275.23 (95% CI, 182.54-358.62), with APGR values being lower in patients who experienced recurrence (243.69 vs 288.68) or who died (237.04 vs 306.03).

Advanced age, large tumor diameter, advanced metastatic stage, and high carcino-embryonic antigen levels were all associated with low visceral protein ratios, with recurrence and mortality rates increasing as the visceral protein ratio increased. AGR had a prognostic stratification on the PFS and OS of colon cancer within 5 years, and patients with low PGR had significant worse PFS and OS. These survival rate were also significantly lower in the low APGR group (PFS, 48.7 vs 73.6; OS, 47.6% vs 70.5%). High values for AGR, PGR, and APGR were all associated with increased risk of PFS, and AGR was identified as an independent predictor for recurrence (OR, 0.779; 95% CI, 0.637-0.954).

There were some limitations to this study. The data were from a single center and evaluated through a retrospective analysis, which could affect the results. The sample size was also smaller due to this study design, and the study only focused on visceral protein markers that are widely used. Further studies will need to be performed to confirm these results.

The researchers concluded that lower levels of AGR, PGR, and APGR were associated with lower PFS and OS outcomes overall in patients with colon cancer. APGR specifically could be used as a means of forecasting prognosis in patients with colon cancer due to its superior performance.

References

1. Xie H, Wei L, Liu M, et al. Prognostic value of visceral protein ratios in patients with colon cancer. Heliyon. 2024;10:e39326. doi:10.1016/j.heyliyon.2024.e39326

2. Colorectal cancer: key facts. World Health Organization. July 11, 2023. Accessed November 5, 2024. https://www.who.int/news-room/fact-sheets/detail/colorectal-cancer