Abstract
Objective
Albumin–globulin ratio (AGR), which is calculated by dividing serum albumin by serum globulin, is considered as a cancer-related inflammation biomarker. Although the prognosis of many solid cancers has been shown to be associated with AGR, there are no studies to demonstrate the association between the prognosis of thyroid cancer and AGR. The purpose of this study is to reveal the relationship between AGR and overall survival (OS) in patients with thyroid cancer who received radioactive iodine therapy (RIT).
Methods
Eighty-eight patients with thyroid cancer who had received RIT for the first time in our institution were included. The values before RIT were adopted as initial measurements for serum albumin, globulin, and thyroglobulin (Tg) and used for analysis. Patients were divided into two groups based on the AGR value. We analyzed the relationship between clinical factors and treatment outcome.
Results
The median follow-up period was 92.4 months (range: 30.1–173.9 months). The 5-year OS and progression-free survival (PFS) were 94% and 54%, respectively. Seventeen patients (< 65 years, 8; and ≥ 65 years, 9) died during the follow-up period. Low AGR was significantly associated with OS in both univariate and multivariate analyses (p = 0.0059 and p = 0.0120, respectively). As the 5-year OS was as high as 94%, there was no significant difference in survival rate between the two groups during the first 5 years. However, there seemed to be a remarkable difference in 10 years after the first RIT. On the other hand, Tg was significantly associated with PFS in both univariate and multivariate analyses (p = 0.0016 and p = 0.0441, respectively). In patients under the age of 65, the PFS rate was significantly lower in the low AGR group (p < 0.0001), while there was no difference in PFS rate between the two AGR groups in patients aged 65 years or older.
Conclusions
AGR may be used as a prognostic factor in relatively younger patients with thyroid cancer treated with radioiodine, while it may be less useful in the older. Overall, it may be an independent prognostic factor for long-term survival in those with thyroid cancer.
Similar content being viewed by others
References
Vecchia CL, Malvezzi M, Bosetti C, Garavello W, Bertuccio P, Levi F, et al. Thyroid cancer mortality and incidence: a global overview. Int J Cancer. 2015;136:2187–95.
Song H-J, Qiu Z-L, Shen C-T, Wei W-J, Luo Q-Y. Pulmonary metastases in differentiated thyroid cancer: efficacy of radioiodine therapy and prognostic factors. Eur J Endocrinol. 2015;173:399–408.
Nixon IJ, Whitcher MM, Palmer FL, Tuttle RM, Shaha AR, Shah JP, et al. The impact of distant metastases at presentation on prognosis in patients with differentiated carcinoma of the thyroid gland. Thyroid. 2012;22:884–9.
Wang R, Zhang Y, Tan J, Zhang G, Zhang R, Zheng W, et al. Analysis of radioiodine therapy and prognostic factors of differentiated thyroid cancer patients with pulmonary metastasis: an 8-year retrospective study. Medicine (Baltimore). 2017. https://doi.org/10.1097/MD.0000000000006809.
Bandeira L, Padovani RDP, Ticly AL, Cury AN, Scalissi NM, Marone MMS, et al. Thyroglobulin levels before radioactive iodine therapy and dynamic risk stratification after 1 year in patients with differentiated thyroid cancer. Arch Endocrinol Metab. 2017;61:590–9.
Choi YM, Kim WG, Kwon H, Jeon MJ, Lee JJ, Ryu J-S, et al. Early prognostic factors at the time of diagnosis of bone metastasis in patients with bone metastases of differentiated thyroid carcinoma. Eur J Endocrinol. 2016;175:165–72.
Spencer CA, Takeuchi M, Kazarosyan M, Wang CC, Guttler RB, Singer PA, et al. Serum thyroglobulin autoantibodies: prevalence, influence on serum thyroglobulin measurement, and prognostic significance in patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab. 1998;83:1121–7.
Görges R, Maniecki M, Jentzen W, Sheu SN-Y, Mann K, Bockisch A, et al. Development and clinical impact of thyroglobulin antibodies in patients with differentiated thyroid carcinoma during the first 3 years after thyroidectomy. Eur J Endocrinol. 2005;153:49–55.
He J, Pan H, Liang W, Xiao D, Chen X, Guo M, et al. Prognostic effect of albumin-to-globulin ratio in patients with solid tumors: a systematic review and meta-analysis. J Cancer. 2017;8:4002–10.
Königsbrügge O, Posch F, Riedl J, Reitter E-M, Zielinski C, Pabinger I, et al. Association between decreased serum albumin with risk of venous thromboembolism and mortality in cancer patients. Oncologist. 2016;21:252–7.
Shimizu T, Ishizuka M, Shibuya N, Tanaka G, Abe A, Aoki T, et al. Preoperative globulin-to-albumin ratio predicts outcome after curative resection in patients with gastric cancer. Ann Gastroenterol Surg. 2018;2:367–75.
Hachiya H, Ishizuka M, Takagi K, Iwasaki Y, Shibuya N, Nishi Y, et al. Clinical significance of the globulin-to-albumin ratio for prediction of postoperative survival in patients with colorectal cancer. Ann Gastroenterol Surg. 2018;2:434–41.
Xu Y, Xu X, Xi C, Ye N, Wang Y. Prognostic value of preoperative albumin to globulin ratio in elderly patients with rectal cancer. Medicine (Baltimore). 2019. https://doi.org/10.1097/MD0000000000016066.
Duran AO, Inanc M, Karaca H, Dogan I, Berk V, Bozkurt O, et al. Albumin-globulin ratio for prediction of long-term mortality in lung adenocarcinoma patients. Asian Pac J Cancer Prev. 2014;15:6449–53.
Deng Y, Pang Q, Miao R-C, Chen W, Zhou Y-Y, Bi J-B, et al. Prognostic significance of pretreatment albumin/globulin ratio in patients with hepatocellular carcinoma. Oncol Targets Ther. 2016;9:5317–28.
Koparal MY, Polat F, Cetin S, Bulut EC, Sözen TS. Prognostic role of preoperative albumin to globulin ratio in predicting survival of clear cell renal cell carcinoma. Int Braz J Urol. 2018;44:933–46.
Hussain A, Almenfi HF, Almehdewi AM, Hamza MS, Bhat MS, Vijayashankar NP. Laboratory features of newly diagnosed multiple myeloma patients. Cureus. 2019. https://doi.org/10.7759/cureus.4716.
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mander SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133.
Brose MS, Nutting CM, Jarzab B, Elisei R, Siena S, Bastholt L, et al. Sorafenib in locally advanced or metastatic, radioactive iodine-refractory, differentiated thyroid cancer: a randomized, double-blind, phase 3 trial. Lancet. 2014;384:319–28.
Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors. 8th ed. Hoboken: Wiley; 2017.
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.
Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454:436–44.
Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420:860–7.
Gomi I, Fukushima H, Shiraki M, Miwa Y, Ando T, Takai K, et al. Relationship between serum albumin level and aging in community-dwelling self-supported elderly population. J Nutr Sci Vitaminol. 2007;53:37–42.
Wu C-Y, Hu H-Y, Huang N, Chou Y-C, Li C-P, Chou Y-J. Albumin levels and cause-specific mortality in community-dwelling older adults. Prev Med. 2018;112:145–51.
Salive ME, Cornoni-Huntley J, Phillips CL, Guralnik JM, Cohen HJ, Ostfeld AM, et al. Serum albumin in older persons: relationship with age and health status. J Clin Epidemiol. 1992;45:213–21.
Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J. 2010. https://doi.org/10.1186/1475-2891-9-69.
Zhong Z, Sanchez-Lopez KM. Autophagy, inflammation and immunity: a troika governing cancer and its treatment. Cell. 2016;166:288–98.
Hu D, Zheng H, Liu H, Li M, Ren W, Liao W, et al. Immunoglobulin expression and its biological significance in cancer cells. Cell Mol Immunol. 2008;5:319–24.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Takata, N., Miyagawa, M., Matsuda, T. et al. Usefulness of albumin–globulin ratio as a clinical prognostic factor in patients with thyroid cancer treated with radioiodine. Ann Nucl Med 35, 1015–1021 (2021). https://doi.org/10.1007/s12149-021-01635-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12149-021-01635-2