# Prognostic Value of the Pre-treatment Albumin-to-Alkaline Phosphatase Ratio in Patients With Metastatic Colorectal Cancer

## TL;DR

This study found that a blood test measuring the ratio of albumin to alkaline phosphatase may predict survival in patients with advanced colorectal cancer.

## Contribution

The study introduces the albumin-to-alkaline phosphatase ratio (AAPR) as a potential new prognostic biomarker for metastatic colorectal cancer.

## Key findings

- A lower pre-treatment AAPR was associated with worse overall survival in metastatic colorectal cancer patients.
- AAPR showed a stronger univariable association with survival than NLR or PLR in this patient group.
- Median overall survival was 11 months for low-AAPR patients versus 21 months for high-AAPR patients.

## Abstract

Objective: This study aimed to evaluate the prognostic significance of the albumin-to-alkaline phosphatase ratio (AAPR) in patients with metastatic colorectal cancer (mCRC) and compare it with the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in the same patient cohort.

Methods: This retrospective study included patients who were followed for mCRC and whose pre-treatment albumin, alkaline phosphatase (ALP), NLR, and PLR values ​​were obtained. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal AAPR, NLR, and PLR cut-off values.

Results: This study included 182 patients. The patients’ median age was 57 (18-87) years, 110 (60.4%) were men, 162 (89%) had de novo metastatic disease, and 75 (41.2%) had right colon cancer. ROC analysis for the pre-treatment AAPR value of OS yielded an AUC of 0.622 (95% confidence interval (CI): 0.548-0.693, p=0.040), and the optimal AAPR cut-off value was ≤0.323. The median AAPR was lower in patients with liver metastasis than in those without (p=0.018) and in de novo metastatic patients than in recurrent patients (p=0.001). Median progression-free survival was longer in recurrent patients than in de novo metastatic patients (11 vs. 7 months, p=0.018). Univariate analysis showed that the AAPR significantly predicted OS (hazard ratio: 0.23,95% CI: 0.08-0.62, p=0.004), whereas NLR and PLR did not (p=0.718 and p=0.403, respectively). Median OS was 16 months (95% CI: 12.7-19.3) in all patients, 11 (95% CI: 7.5-14.5) months in the low-AAPR group, and 21 (95% CI: 17.4-24.6) months in the high-AAPR group (p=0.008).

Conclusion: In patients with mCRC, the OS was worse in the low-AAPR group than in the high-AAPR group. The AAPR showed a stronger univariable association with OS than NLR/PLR in this cohort, but did not retain independent significance in multivariable analysis; prospective validation is needed.