Relationship Between Preoperative Albumin Alkaline Phosphatase Ratio And Survival Time After Radical Prostatectomy

Background:Prostate cancer is often considered a major health concern for men worldwide,and it is the second most common cancer among men worldwide.According to the Global Disease Study,its morbidity and mortality rates have increased annually over the past 30 years.The global age-standardized incidence and mortality rates for prostate cancer in 2020 were 30.7 and 7.7 per 100,000,respectively.Radical prostatectomy is the standard operation for localized prostate cancer.At present,the common postoperative problems are the occurrence of Biochemical recurrence(BCR)and tumor progression such as lymph node metastasis and bone metastasis.The TNM staging system is the most important and widely used prognostic factor at present.However,previous studies have shown that this staging system sometimes fails to predict prognosis with great accuracy.Therefore,it is very important to predict tumor prognosis through various serum markers that can be easily obtained,and albumin-to-alkaline phosphatse ratio(AAPR)is a new indicator of cancer prognosis.Its prognostic effect has been confirmed in a variety of malignancies.For the urinary system,there have been studies on bladder cancer,ureteral cancer and kidney cancer,while the relationship between preoperative AAPR and prostate cancer has not been studied.This study is to explore the relationship between preoperative albumin alkaline phosphatase ratio and postoperative survival of prostate cancer.Objective:To investigate the relationship between preoperative albumin alkaline phosphatase ratio and postoperative survival of prostate cancer after radical operation.Methods:Clinical and pathological data of 102 patients with localized prostate cancer admitted to Henan Provincial People’s Hospital from May 2015 to October 2019 were retrospectively analyzed.Study object data were collected,including patient age,preoperative PSA,preoperative albumin,preoperative alkaline phosphatase,Gleason score after radical resection,preoperative clinical grade,postoperative pathological grade,positive margin,and progression-free survival(PFS).Overall survival(OS).The preoperative albumin-to-alkaline phosphatse ratio(AAPR)was calculated,and Receiver Operating Characteristic curve(Receiver Operating Characteristic curve)was used to calculate the preoperative albumin-to-alkaline phosphatse ratio(AAPR).ROC)will find out the optimal cut-off value and divide the patients into the high AAPR group and the low AAPR group,and analyze whether there is difference between the factors in the two groups.Univariate and multivariate risk regression analyses were performed by Cox proportional risk regression model,and survival curves were drawn by Kaplan-Meier method to compare the difference in progression-free survival and overall survival rates between the two groups.Finally,a nomogram was constructed to predict the survival of the patients using Cox regression curves.Results:1.Comparison of baseline data:there were no significant differences in age,preoperative PSA,preoperative albumin,disease progression-free time,overall survival time,Gleason score after radical resection,preoperative clinical grade,postoperative pathological grade,and proportion of positive margin between the two groups(P>0.05).There was statistical significance in the proportion of alkaline phosphatase and AAPR before operation(P<0.05).2.Univariate Cox regression analysis with progression-free survival as the target end point:albumin(P<0.05),alkaline phosphatase(P<0.05),AAPR(P<0.05),PSA(P<0.05),clinical stage(P<0.05),postoperative pathological stage(P<0.05).Age(P=0.379),Gleason score(P=0.533),positive margin(P=0.192).Univariate Cox regression with overall survival as the target end point:Albumin(P=0.929),alkaline phosphatase(P=0.550),AAPR(P=0.128),age(P=0.834),PSA(P=0.665)Gleason score(P=0.800),clinical stage(P=0.545),postoperative pathological stage(P=0.991),The margin was positive(P=0.872).3.Multivariate Cox regression survival model was established with P<0.05 as screening condition.AAPR(HR=2.408,95%CI:1.032-5.618,P=0.042),PSA(HR=0.505,95%CI:0.198-1.287,P=0.152),clinical stage(HR=1.097,95%CI:0.333-3.615,P=0.879),postoperative pathological stage(HR=0.633,95%CI:0.199-2.014,P=0.439).AAPR are independent risk factors for RFS after radical prostatectomy.The risk of biochemical recurrence was 2.4 times higher in patients with low AAPR than in those with high AAPR.There is no significant correlation between AAPR and disease OS after radical prostatectomy.4.According to the survival curve function of AAPR and disease PFS and OS,there is a significant difference in RFS between high AAPR and low AAPR groups,with statistical significance(P(Sig.)=0.005 by Log Rank test and P(Sig.)=0.006 by Breslow test).Patients with high AAPR had higher PFS than those with low AAPR,a significant difference.The Log Rank test results of AAPR and OS survival curves were P(Sig.)=0.088(P>0.05),and THE Breslow test results were P(Sig.)=0.046(P<0.05).Compared with Breslow,Log Rank focuses more on long-term effects,so it can be seen from the survival function that in the short-term survival period,the OS of the high AAPR group is higher than that of the low AAPR group,and there is a significant difference.However,in the long run,there is no significant difference in OS between the two groups.5.According to the results of Cox regression model,the independent prognostic indicators AAPR and the indicators of significance(P<0.05)in univariate regression analysis,including PSA,clinical tumor stage and pathological tumor stage,were used to make a line graph to predict PFS at 3 and 5 years after operation.The C index was as follows:0.719,95%CI:0.633-0.805,C index>0.71,it can be seen that the prediction model is of medium accuracy.This line chart predicts that the calibration curve of the 3-year PFS will perform poorly under the ideal model,while the calibration curve of the 5-year PFS will perform well under the ideal model.Conclusion:1.For patients with prostate cancer after radical surgery,AAPR were independent risk factors for PFS before surgery,and the risk of BCR was 2.4 times higher in the low AAPR group(<0.533)than in the high AAPR group(>0.533).2.With the extension of RFS time,the survival rate of high AAPR group was significantly higher than that of low AAPR group.3.With the extension of OS time,the short-term survival rate of high AAPR was higher than that of low AAPR group.However,in the long run,there was no significant difference in OS between the two groups.4.The rotigrams model created by AAPR combined with traditional prognostic indicators can accurately predict the PFS 5 years after surgery.