Clinical significance of the albumin-to-globulin ratio in overweight or obese elderly patients with cancer: A multicenter observational study

Abstract Background Elderly patients with cancer who are overweight or obese tend to show signs of inflammation or malnutrition. The albumin-to-globulin ratio (AGR) is a clinical indicator of the nutritional status and presence of systemic inflammation in cancer patients. However, its predictive value in this specific population has not yet been elucidated. Methods This study, comprising 917 overweight or obese elderly cancer patients, was conducted as a multicenter clinical trial. The relationship between the AGR and survival outcome was assessed using Kaplan-Meier survival curve analyses and the Cox regression model for HRs . Additionally, the prognostic value of the pretreatment AGR was validated by performing a propensity score matching analysis. Results The optimal cutoff value for a low AGR was 1.25. A notable decrease in the risk of all-cause mortality was observed with each increase in the AGR value. Specifically, for every standard deviation increase, the HR was 0.83 ( 95% CI : 0.74–0.93, P = 0.001). After adjustment, it was determined that a decreased AGR was independently linked to a worse prognosis among elderly cancer patients who were overweight or obese ( HR : 1.79, 95% CI : 1.40–2.27, P < 0.001). In addition, a reduced AGR is correlated with poorer outcomes in the context of certain malignancies, particularly lung, upper gastrointestinal, and colorectal malignancies. Notably, the effect of the AGR on the overall survival was influenced by the Eastern Cooperative Oncology Group performance status. The validity of our primary findings was confirmed through a propensity score matching analysis, which accounted for potential confounding factors. Conclusions A reduced AGR is linked to a poor prognosis, particularly when concurrent with a poor Eastern Cooperative Oncology Group performance status in overweight or obese elderly cancer patients.