Cancer Management and Research (May 2019)

Prognostic impact of the pretreatment albumin to alkaline phosphatase ratio for nonmetastatic breast cancer patients

  • Long ZQ,
  • Hua X,
  • Zhang WW,
  • Lv SW,
  • Deng JP,
  • Guo L,
  • He ZY,
  • Lin HX

Journal volume & issue
Vol. Volume 11
pp. 4809 – 4814

Abstract

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Zhi-Qing Long,1,* Xin Hua,1,* Wen-Wen Zhang,1 Shao-Wen Lv,1 Jia-Peng Deng,1 Ling Guo,2 Zhen-Yu He,1 Huan-Xin Lin11Department of Radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China; 2Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China*These authors contributed equally to this workIntroduction: Albumin and alkaline phosphatase have been previously demonstrated as independent prognostic factors for various types of cancer. Here, we aimed to explore the potential value of pretreatment albumin to alkaline phosphatase ratio (AAPR) on overall survival (OS) in nonmetastatic breast cancer patients.Methods: A total of 746 nonmetastatic breast cancer patients were enrolled in this study. Receiver characteristic curve was used to analyze the AAPR threshold. Survival analysis was conducted using the Kaplan–Meier method and compared with the log-rank test. Both univariate and multivariate analyses were performed using Cox proportional hazards regression methodology.Results: The optimal cutoff value of AAPR in predicting OS in nonmetastatic breast cancer patients was 0.525. Increased pretreatment AAPR level was related to age at diagnosis (≥60 years vs <60 years, P=0.000), tumor size (T≤2 cm vs T>2 cm, P=0.034), estrogen receptor (positive vs negative, P=0.022), progesterone receptor (positive vs negative, P=0.025), carcino-embryonic antigen (abnormal vs normal, P=0.016), surgery (lumpectomy vs mastectomy, P=0.002), chemotherapy (yes vs no, P=0.004), radiotherapy (yes vs no, P=0.013), endocrine therapy (yes vs no, P=0.027) but not with lymph node involvement, HER-2 status or CA-153. The 5-year OS rate was 80.16% for the low AAPR group and 92.66% for the high AAPR group. Kaplan–Meier analysis indicated that patients with low-AAPR levels had shorter OS than patients with high-AAPR levels (P=0.001). N classification (P<0.05), Ki-67 (HR=3.603, 95% CI=1.046–12.414, P=0.042) and AAPR (HR=0.447, 95% CI=0.205–0.976, P=0.043) were related to OS in multivariate analyses, respectively.Conclusion: AAPR is an independent prognostic factor for OS in nonmetastatic breast cancer patients. Further prospective studies are required to confirm our findings.Keywords: nonmetastatic breast cancer, prognosis, pretreatment albumin, alkaline phosphatase

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