Albumin–globulin ratio is a predictive biomarker of antitumour effect of immune checkpoint inhibitors in cancer patients

Immune checkpoint inhibitors (ICIs) have transformed cancer therapy, yet the heterogeneity of treatment responses underscores the need for reliable prognostic biomarkers. The albumin-to-globulin ratio (AGR), an indicator of systemic inflammation and nutritional status, has emerged as a potential predictor of ICI outcomes. This study aimed to systematically evaluate the prognostic significance of AGR in patients receiving ICIs through a meta-analysis and to validate the findings in a single-centre cohort.
A systematic literature search was conducted using PubMed, EMBASE, and the Cochrane Library to identify studies published prior to June 6, 2025. The primary endpoints were overall survival (OS), progression-free survival (PFS), and disease control rate (DCR). In addition, a retrospective analysis was performed on a cohort of 74 patients with renal cell carcinoma (RCC) treated with ICIs at our institution to assess the prognostic value of baseline AGR in relation to OS and PFS.
Seven studies encompassing 1,460 patients were included in the meta-analysis. Higher pretreatment AGR was significantly associated with improved OS (HR = 0.44; 95% CI: 0.30–0.66; p < 0.001), extended PFS (HR = 0.61; 95% CI: 0.53–0.71; p < 0.001), and superior DCR (OR = 4.48; 95% CI: 2.58–7.77; p < 0.001). Sensitivity analyses confirmed the robustness of these associations. In our institutional RCC cohort, elevated AGR was independently linked to prolonged OS (p = 0.017) and PFS (p = 0.030), consistent with findings from the pooled data.
AGR is a simple, inexpensive, and non-invasive biomarker with significant prognostic value in patients undergoing ICI therapy. These findings support its potential role in guiding clinical decision-making and optimizing patient selection for immunotherapy.

免疫检查点抑制剂（immune checkpoint inhibitors, ICIs）已彻底改变癌症治疗格局，但治疗应答的异质性凸显了对可靠预后生物标志物的迫切需求。白蛋白球蛋白比值（albumin-to-globulin ratio, AGR）作为全身炎症与营养状态的评估指标，已成为ICI治疗结局的潜在预测因子。本研究旨在通过荟萃分析系统评估AGR在接受ICI治疗患者中的预后价值，并在单中心队列中验证上述研究结果。
研究通过PubMed、EMBASE及Cochrane Library开展系统文献检索，筛选2025年6月6日前发表的相关研究。本研究的主要终点为总生存期（overall survival, OS）、无进展生存期（progression-free survival, PFS）及疾病控制率（disease control rate, DCR）。此外，本研究对本机构接受ICI治疗的74例肾细胞癌（renal cell carcinoma, RCC）患者队列进行回顾性分析，以评估基线AGR与OS、PFS的预后价值。
荟萃分析共纳入7项研究，涉及1460例患者。治疗前较高的AGR水平与更佳的总生存期（风险比hazard ratio, HR=0.44；95%置信区间confidence interval, CI：0.30~0.66；p<0.001）、更长的无进展生存期（HR=0.61；95%CI：0.53~0.71；p<0.001）及更高的疾病控制率（比值比odds ratio, OR=4.48；95%CI：2.58~7.77；p<0.001）显著相关。敏感性分析证实了上述关联的稳健性。在本机构的RCC队列中，升高的AGR水平与更长的OS（p=0.017）及PFS（p=0.030）独立相关，与合并数据的研究结果一致。
AGR是一种简便、廉价且无创的生物标志物，在接受ICI治疗的患者中具有显著的预后价值。本研究结果支持其在指导临床决策及优化免疫治疗患者筛选中的潜在应用价值。