The serum albumin-to-globulin ratio (AGR) is an independent protective factor for overall survival (OS) in patients with advanced non-small-cell lung cancer (NSCLC) receiving anlotinib therapy, according to study findings published in BMC Pulmonary Medicine.
Investigators sought to explore the association between AGR and OS in patients with advanced NSCLC who are treated with anlotinib. The primary endpoint was OS (ie, the time from the date of initial anlotinib treatment to death or last follow-up).
Investigators conducted a retrospective cohort study from June 2018 through May 2021 that included 196 patients admitted to the Department of Pulmonary and Critical Care Medicine of Zhongshan Hospital in Fujian, China, with advanced NSCLC who were treated with anlotinib.
Median (range) follow-up time was 7.64 (0.59-32.98) months, during which time nearly half (49.49%) of patients died. Average age of patients was 60.4 years, and 36% were women.
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These findings further expand the potential role of AGR as a prognostic predictor in advanced NSCLC patients treated with anlotinib.
The investigators found a nonlinear relationship between AGR and OS with the change in direction (inflection point) at 1.24. The researchers noted the hazard ratio (HR) on the left side of the inflection point was 13.05 (95% CI, 0.52-327.64), indicating no association between AGR and OS. On the right side of the inflection point, HR was 0.20 (95% CI, 0.07-0.57). This suggests a positive association between AGR and OS when AGR is greater than 1.24 (and that for every 1 unit increase in AGR, risk of death decreases approximately 80%).
Univariate analysis showed a positive association between OS and albumin (HR, 0.92; 95% CI, 0.88-0.95; P <.0001), female sex (HR, 0.60; 95% CI, 0.38-0.92; P =.0201), and AGR (HR, 0.47; 95% CI, 0.26-0.84; P =.0105). Multiple factors including age, never having smoked, hypertension, and previous targeted therapy were not associated with OS in this analysis.
Investigators noted for each additional unit increase of AGR, risk of death was approximately 53% lower according to the nonadjusted multivariate linear regression model. The minimally adjusted model (adjusted for sex, age, never having smoked) also showed a 53% reduced risk of death. The fully adjusted AGR model still showed a positive association with approximately 40% reduced risk of death.
Study limitations include the retrospective cohort design as well as bias of selection, detection, and analysis.
“The relationship between AGR and OS for advanced NSCLC patients treated with anlotinib is non-linear,” investigators concluded, adding, “AGR is positively correlated with OS when AGR is higher than 1.24.” They further stated, “These findings further expand the potential role of AGR as a prognostic predictor in advanced NSCLC patients treated with anlotinib.”
