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dc:title: results
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rdf:value: The median baseline EBV DNA viral load was 4.67 × >>104<< copies/ml (range: 0-9.19 × 107 copies/ml).
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Subject Item: _:vb62169074
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rdf:value: The median baseline EBV DNA viral load was 4.67 × 104 copies/ml (range: 0-9.19 × >>107<< copies/ml).
n3:mentions: n2:20103659

Subject Item: _:vb62169075
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rdf:value: However, an AAPR < 0.447 was significantly associated with a higher LDH level (273 versus 185 U/L, P = 0.004), a higher EBV DNA viral load (5.59 ×105 versus 3.49 × >>104<< copies/ml, P = 0.001), and more liver and bone metastases (49.3% versus 28.2%, P = 0.005; 58.2% versus 33.8%, P = 0.001, respectively).
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dc:title: methods
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rdf:value: from the initial diagnosis to disease progression or death from any cause. Our final follow-up was on January 31, 2016. The optimal cutoff level of AAPR was determined by a web-based system, R software, designed by Budczied et al.>>13<< Baseline characteristics were compared using Chi-squared test or Fisher's exact test.
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Subject Item: _:vb62169078
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dc:title: discussion
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Subject Item: _:vb62169079
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rdf:value: ALB, the most abundant serum protein, is considered a nutritional index with the ability to stabilize cell growth and DNA replication, buffer various biochemical changes, and exert antioxidant effects against carcinogens.>>14<< In addition, malnutrition, which is reflected by low ALB, can weaken human defense mechanisms such as cellular and humoral immunity and phagocytic function, leading to the increasing possibility of infection and the poor response to
n3:mentions: n2:24751830

Subject Item: _:vb62169080
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rdf:value: which is reflected by low ALB, can weaken human defense mechanisms such as cellular and humoral immunity and phagocytic function, leading to the increasing possibility of infection and the poor response to anti-cancer treatment.>>15<< Recently, ALB has become a popular biomarker for the prediction of survival in various malignancies, including colorectal cancer, osteosarcoma, hepatocellular carcinoma, renal cell carcinoma and prostate cancer.
n3:mentions: n2:10604203

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rdf:value: and an imbalanced tumor microenvironment. A high concentration of interleukin 6 (IL-6) and tumor necrosis factor (TNF) can modulate the production of albumin in hepatocytes and increase the permeability of the microvasculature.>>21<< Furthermore, EBV, a well-known prognostic factor in NPC regardless of stage, has the ability to stimulate the release of pro-inflammatory cytokines, including IL-6 and TNF, which pathologically intensifies these processes.
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rdf:value: Furthermore, EBV, a well-known prognostic factor in NPC regardless of stage, has the ability to stimulate the release of pro-inflammatory cytokines, including IL-6 and TNF, which pathologically intensifies these processes.>>22<<
n3:mentions: n2:25891128

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rdf:value: various types of molecules, including nucleotides, proteins and alkaloids.23 Although almost all tissues throughout the entire body contain this enzyme, it is specifically concentrated in the bone, liver, bile duct, kidney and placenta.>>24<< More ALP will be released into the blood stream during some pathological conditions, including pregnancy, hepatocellular carcinoma, kidney disease and bone metastasis.
n3:mentions: n2:4517947

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rdf:value: concentrated in the bone, liver, bile duct, kidney and placenta.24 More ALP will be released into the blood stream during some pathological conditions, including pregnancy, hepatocellular carcinoma, kidney disease and bone metastasis.>>25<<-28 Particularly, elevated ALP is frequently reported in bone metastasis in certain malignancies, including osteosarcoma, breast cancer and prostate cancer.
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Subject Item: _:vb62169085
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rdf:value: pregnancy, hepatocellular carcinoma, kidney disease and bone metastasis.25-28 Particularly, elevated ALP is frequently reported in bone metastasis in certain malignancies, including osteosarcoma, breast cancer and prostate cancer.>>20<<,29-30 Jin et al reported that serum ALP predicted a worse survival outcome in patients with skeletal and/or liver metastasis of NPC.
n3:mentions: n2:26685010

Subject Item: _:vb62169086
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rdf:value: pregnancy, hepatocellular carcinoma, kidney disease and bone metastasis.25-28 Particularly, elevated ALP is frequently reported in bone metastasis in certain malignancies, including osteosarcoma, breast cancer and prostate cancer.20,>>29<<-30 Jin et al reported that serum ALP predicted a worse survival outcome in patients with skeletal and/or liver metastasis of NPC.
n3:mentions: n2:22333159 n2:25524924

Subject Item: _:vb62169087
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rdf:value: 20,29-30 Jin et al reported that serum ALP predicted a worse survival outcome in patients with skeletal and/or liver metastasis of NPC.>>31<<
n3:mentions: n2:26017793

Subject Item: _:vb62169088
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rdf:value: and colleagues first proposed the concept of the AAPR and proved that the AAPR was an independent prognostic factor for overall survival and disease-free survival for patients with hepatocellular carcinoma receiving curative surgery.>>12<< Additionally, we hypothesized that merging ALB and ALP into a new index may have a novel prognostic value and better predicted the survival of patients with metastatic NPC.
n3:mentions: n2:25737613

Subject Item: _:vb62169089
rdf:type: n5:Section
dc:title: background
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Subject Item: _:vb62169090
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rdf:value: Meanwhile, 5-6% of NPC patients are identified as having disseminated disease at initial diagnosis.>>2<< Under this condition, systematic therapy remains the primary option.
n3:mentions: n2:11408815

Subject Item: _:vb62169091
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rdf:value: markers have been investigated to provide prognostic information, including the TNM staging system, Epstein-Barr virus (EBV) DNA viral load, C-reactive protein, lactate dehydrogenase (LDH), albumin (ALB) and alkaline phosphatase (ALP).>>4<<-9 Some combined indexes of clinical characteristics and laboratory biomarkers have also been proven to be prognostic factors, such as the C-reactive protein-to-albumin ratio, neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte
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Subject Item: _:vb62169092
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rdf:value: indexes of clinical characteristics and laboratory biomarkers have also been proven to be prognostic factors, such as the C-reactive protein-to-albumin ratio, neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR).>>10<<-11 However, the albumin-to-alkaline phosphatase ratio (AAPR), which is a novel prognostic factor for hepatocellular carcinoma (HCC), has not yet been studied in metastatic NPC patients.
n3:mentions: n2:24327524 n2:24386144

Subject Item: _:vb62169093
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rdf:value: (NLR) and monocyte-to-lymphocyte ratio (MLR).10-11 However, the albumin-to-alkaline phosphatase ratio (AAPR), which is a novel prognostic factor for hepatocellular carcinoma (HCC), has not yet been studied in metastatic NPC patients.>>12<< Therefore, it is of interest to determine whether AAPR can also be applied to metastatic NPC.
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