Prognostic Effect of Albumin-to-Globulin Ratio in Patients with Advanced Epithelial Ovarian Cancer Receiving Neoadjuvant Chemotherapy

Abstract

Background: Advanced epithelial ovarian cancer (EOC) is frequently diagnosed at an advanced stage and remains associated with poor survival despite multimodal treatment. The albumin-to-globulin ratio (AGR), a composite marker reflecting nutritional and systemic inflammatory status, has emerged as a potential prognostic biomarker in several malignancies. This study evaluated the prognostic significance of pretreatment AGR in patients with advanced EOC receiving neoadjuvant chemotherapy.

Materials and Methods: This retrospective cohort study included patients with FIGO stage II–IV epithelial ovarian carcinoma treated at Dr. B. Borooah Cancer Institute between January 2019 and June 2023. All patients received at least two cycles of platinum-based neoadjuvant chemotherapy. Pretreatment AGR was calculated by dividing serum albumin by serum globulin concentrations. The optimal AGR cut-off value was determined using receiver operating characteristic (ROC) curve analysis. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan–Meier method and Cox proportional hazards regression models.

Results: A total of 284 patients were included, with a median age of 52 years. Most patients had FIGO stage III disease, and high-grade serous carcinoma was the predominant histological subtype. Low pretreatment AGR (<1.00) was observed in 128 patients, whereas 156 patients had an AGR ≥1.00. Patients with AGR ≥1.00 demonstrated significantly longer median PFS than those with AGR <1.00 (16.1 vs. 13.2 months; p=0.042). Median OS was also significantly longer in the high-AGR group (30.8 vs. 26.3 months; p=0.038). On multivariable Cox regression analysis, AGR <1.00 remained independently associated with poorer PFS (HR, 1.34; 95% CI, 1.01–1.89; p=0.046) and OS (HR, 1.41; 95% CI, 1.02–2.06; p=0.039).

Conclusion: Pretreatment AGR appears to be an inexpensive and readily available prognostic biomarker in patients with advanced epithelial ovarian cancer undergoing neoadjuvant chemotherapy. A low AGR was independently associated with shorter progression-free and overall survival; however, its prognostic discrimination was modest. Larger prospective studies are warranted to validate these findings before AGR can be incorporated into routine clinical risk stratification.