Prognostic Value of Preoperative Albumin-to-Alkaline Phosphatase Ratio for Survival in Colorectal Cancer Patients...

Background and Objectives: This study aimed to evaluate the prognostic significance of the pre-treatment albumin-to-alkaline phosphatase ratio (AAPR) in early-stage colorectal cancer patients and to compare it with the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) within the same patient cohort. Materials and Methods: This retrospective study included 540 patients who were followed up after a diagnosis of early-stage colorectal cancer and whose albumin (ALB), alkaline phosphatase (ALP), neutrophil, platelet, and lymphocyte values were measured before treatment. Results: In the receiver operating characteristic (ROC) curve analysis for overall survival (OS), the AAPR index Area Under Curve (AUC):0.560, (p = 0.018), NLR index (p = 0.079), and PLR index (p = 0.692) were evaluated. In the ROC analysis for OS, a cut-off value of the AAPR index of ≤0.423 was found. In the AAPR-low group, the relapse and death rates were higher than in the AAPR-high group (p = 0.004 and p = 0.001, respectively). As the AAPR index decreased, the NLR and PLR indexes increased (p = 0.027 and p = 0.003, respectively). Median disease-free survival (DFS) was worse in the AAPR-low group (128 versus 156) months (p = 0.015). The AAPR index significantly affected OS with hazard ratio (HR):0.42 (95%CI, 0.18-0.97) (p = 0.044). At 5 years, 68% of the patients in the AAPR-low group and 79% of the patients in the AAPR-high group were alive (p = 0.005). In a multivariate analysis, low AAPR, patient age at diagnosis, TNM stage, and recurrence status were independent factors affecting OS (p = 0.022, p < 0.001, p = 0.002, and p < 0.001, respectively). Conclusions: In early-stage colorectal cancer patients, the OS was worse in the AAPR-low group than in the AAPR-high group. The AAPR index demonstrated significant prognostic value for OS compared to the NLR and PLR in the same patient cohort.