Low albumin-to-alkaline phosphatase ratio is associated with inferior prognosis in patients with head and neck cancer underwent concurrent chemoradiation: A propensity score-matched analysis

Abstract

ABSTRACT Background: Low albumin-to-alkaline phosphatase ratio (AAPR) is associated with tumor progression and poor survival outcome in some malignancies. Purpose: We aimed to determine the prognostic value of AAPR in head and neck cancer (HNC) patients underwent concurrent chemoradiotherapy (CCRT). Materials and Methods: We retrospectively reviewed medical records of 342 patients with HNC treated with definitive or adjuvant CCRT from 2007 to 2017. Receiver-operator characteristic curve assessed the cut-off value and predictive accuracy of AAPR for disease progression. Propensity score-matched (PSM) method was performed to balance baseline characteristics. Multivariate Cox regression analyses screened the independent prognostic factors for progression-free survival (PFS) and overall survival (OS). Results: The median follow-up duration was 40 months. The optimal cut-off level of AAPR was 0.523. In the PSM cohort, an AAPR < 0.523 was related to worse PFS and OS (PFS: Hazard ratio [HR], 1.936; 95% confidence interval [CI], 1.212 to 3.249; P = 0.001 and OS: HR, 1.832; 95% CI, 1.117 to 3.478; P = 0.02) compared with those with an AAPR ≥ 0.523. AJCC stage IVA-B also showed poor survival outcome compared with patients with AJCC stage II--III (PFS: HR, 1.855; 95% CI, 1.173 to 2.933; P = 0.008 and OS: HR, 1.905; 95% CI, 1.131 to 3.211; P = 0.015). Conclusions: HNC patients with low AAPR independently have worse survival outcomes than do high AAPR patients. These findings might help physicians predict treatment outcome and guide treatment strategy in patients with HNC underwent CCRT.