Association of the Preoperative Albumin-to-Globulin Ratio with Pathological Stage and Tumor Grade in Primary Bladder Tumor

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Abstract
Objective: This study aimed to investigate the association between the preoperative albumin-to-globulin ratio (AGR) and pathological stage and tumor grade in patients who underwent transurethral resection of bladder tumor (TURBT) for primary bladder tumors.Materials and Methods: A total of 153 patients who underwent transurethral resection of bladder tumor (TURBT) for primary urothelial carcinoma between March 2017 and February 2020 were included in the study. AGR was calculated using preoperative serum albumin and total protein levels. Among the exclusion criteria were active infection, autoimmune disease, hepatic disease, and concomitant malignancy. The optimal AGR cut-off value was determined using receiver operating characteristic (ROC) curve analysis and the Youden index. Independent predictors of pathological stage (NMIBC/MIBC) and tumor grade (low/high Grade) were evaluated using logistic regression analysis.Results: The median age of the patients was 68 years (IQR: 59–75), and 88.9% were male. The pathological stage distribution was Ta in 39.9%, T1 in 39.9%, and T2 in 20.3% of patients, while tumor grade distribution was low Grade in 54.2% and high Grade in 43.1%. The median AGR value of the cohort was 1.32 (IQR: 1.17–1.50). AGR was significantly lower in both the MIBC group (p = 0.003) and the high-grade group (p < 0.001) compared to their respective counterparts. ROC analysis identified an optimal cut-off value of 1.35 for both clinical outcomes (AUC=0.649, 95% CI: 0.542–0.755 for MIBC and AUC=0.656, 95% CI: 0.568–0.744 for high-grade disease). In multivariate logistic regression analysis, AGR was independently associated with both MIBC (OR=0.16, 95% CI: 0.03–0.97; p = 0.046) and high-grade disease (OR=0.18, 95% CI: 0.04–0.74; p = 0.018).Conclusion: Preoperative AGR is independently associated with pathological stage and tumor grade in primary bladder tumors. The ability to calculate this parameter from routine biochemical tests without additional cost makes it clinically valuable for preoperative risk stratification. Further validation of these findings in larger patient cohorts is warranted.

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