Low albumin-to-globulin ratio associated with cancer incidence and mortality in generally healthy adults
Low albumin-to-globulin ratio associated with cancer incidence and mortality in generally healthy adults
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DOI：
10.1093/annonc/mdu274
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发表时间：
2014-11-01
影响因子：
50.5
通讯作者：
Cho, B.
中科院分区：
文献类型：
--
作者：
Suh, B.;Park, S.;Cho, B.
这项回顾性队列研究确定了白蛋白与球蛋白比率较低的一般健康成人，无论是短期还是长期，癌症发病率和死亡率都较高。低白蛋白-球蛋白比，容易通过血清白蛋白和总蛋白测定，可能在鉴别癌症高危人群方面具有临床应用价值。慢性炎症是致癌的主要步骤之一。识别慢性炎症可能有助于识别癌症风险。先前的研究报道了低白蛋白与球蛋白比率（AGR）与癌症患者癌症死亡率增加有关，但没有基于健康人群的研究。我们的回顾性队列研究包括26 974名30岁及以上的健康成年人，他们到首尔国立大学医院健康促进中心进行自我推荐的健康检查。国家医疗服务索赔数据用于确定癌症发病率，韩国死亡登记数据用于确定死亡率。中位生存随访时间为5.9年（四分位数间4.1年）。与AGR为千分之一日元1.5的受试者相比，AGR为1.1 bb0千分之一日元1.0和1.0 bb1 AGR的受试者的全因死亡率校正危险比（aHR）为2.69（95%置信区间CI， 1.54-4.72）和aHR 6.71 (95% CI 3.56-12.66)，癌症死亡率校正危险比（aHR）为2.95 （95% CI 1.42-6.11）和aHR 4.38 (95% CI 1.57-12.25)，癌症发病率分别为aHR 2.07 （95% CI 1.28-3.36）和aHR 3.99 （95% CI 2.10-7.58）。当从基线开始2年后的癌症发病率单独分析时，AGR为1.1 >（千分之一）和1.0 >（千分之一）的受试者的癌症发病率分别与aHR 1.88 （95% CI 1.01-3.48）和aHR 2.55 （95% CI 1.03-7.11）相关。在所有类型的癌症中，癌症事件都增加了，但在肝脏和血液系统恶性肿瘤中尤其如此。低AGR是癌症发病率和死亡率的一个危险因素，无论是短期还是长期，在一般健康的筛查人群中。本研究的结果需要在更大规模的研究中得到重复，同时还需要确定低AGR的敏感性和其他诊断价值。
This retrospective cohort study identified generally healthy adults with low albumin-to-globulin ratio to be at high risk for cancer incidence and mortality, both short- and long terms. Low albumin-to-globulin ratio, easily determined by serum albumin and total protein, may have clinical utility in identifying those with high cancer risk.Chronic inflammation is known to be one of the main steps in carcinogenesis. Identification of those with chronic inflammation may help identify subjects at risk of cancer. Previous studies have reported low albumin-to-globulin ratio (AGR) to be associated with increased cancer mortality in cancer patients, but there has been no study based on healthy populations.Our retrospective cohort study involved 26 974 generally healthy adults aged 30 or older who visited Seoul National University Hospital Health Promotion Center for self-referred health checkup. National medical service claims data were used to determine cancer incidence, and Korean death registry data was used to determine mortality. Median follow-up time for survival was 5.9 years (interquartile range 4.1 years).Compared with subjects with AGR a parts per thousand yen 1.5, subjects with 1.1 > AGR a parts per thousand yen 1.0 and 1.0 > AGR showed adjusted hazard ratio (aHR) 2.69 (95% confidence interval, CI, 1.54-4.72) and aHR 6.71 (95% CI 3.56-12.66) for all-cause mortality, aHR 2.95 (95% CI 1.42-6.11) and aHR 4.38 (95% CI 1.57-12.25) for cancer mortality, and aHR 2.07 (95% CI 1.28-3.36) and aHR 3.99 (95% CI 2.10-7.58) for cancer incidence, respectively. When cancer incidence events after 2 years from baseline were separately analyzed, subjects with 1.1 > AGR a parts per thousand yen 1.0 and 1.0 > AGR were associated with aHR 1.88 (95% CI 1.01-3.48) and aHR 2.55 (95% CI 1.03-7.11) for cancer incidence, respectively. Cancer events were increased in all types of cancer, but especially in liver and hematologic malignancies.Low AGR is a risk factor for cancer incidence and mortality, both short- and long terms, in a generally healthy screened population. The results of this study need to be replicated in larger studies, along with the determination of the sensitivity and other diagnostic values of low AGR.