Systemic prognostic score and nomogram based on inflammatory, nutritional and tumor markers predict cancer-specific survival in stage II-III gastric cancer patients with adjuvant chemotherapy
Systemic prognostic score and nomogram based on inflammatory, nutritional and tumor markers predict cancer-specific survival in stage II-III gastric cancer patients with adjuvant chemotherapy
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DOI：
10.1016/j.clnu.2018.07.015
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发表时间：
2019-08-01
影响因子：
6.3
通讯作者：
Zhou, Zhiwei
中科院分区：
文献类型：
--
作者：
Liu, Xuechao;Wu, Zhiming;Zhou, Zhiwei
背景：探讨几种已建立的炎症、营养和肿瘤标志物的临床应用，并基于术前预后标志物构建新的评分系统来预测胃癌（GC）的预后。方法：我们回顾性评估了2000年至2012年连续688例II-III期胃癌患者接受根治性切除后辅助化疗。结果：在多因素分析中，c反应蛋白/白蛋白（CRP/Alb）比值（>0.2）、预后营养指数（PNI）（评分1）、术前体重减轻（>6%）和碳水化合物抗原19-9 (CA 19-9) （>27 U/mL）独立预测不利的癌症特异性生存（CSS）。4项术前预后指标各1分。然后，在总评分的基础上构建新的系统预后评分（SPS）。多因素分析显示，SPS是CSS的独立预测因子（P < 0.001）。SPS为0、1、2或3/4的患者5年CSS发生率分别为67.2%、45.3%、29.0%和10.6%（0∶1 [P < 0.001]、1∶2 [P = 0.031]和2∶3/4 [P = 0.004]）。SPS 0、SPS 1、SPS 2和SPS 3/4的中位生存时间分别为68.7、47.1、28.3和16.3个月。SPS的受试者工作特征（ROC）曲线下面积高于其他指标（P < 0.001）。此外，综合TNM分期、肿瘤位置和SPS的nomogram鉴别能力优于单独TNM分期（C-index分别为0.714和0.630,P < 0.001）。结论：术前SPS联合炎症、营养和肿瘤标志物独立预测辅助化疗II-III期胃癌患者术后生存。(C) 2018爱思唯尔有限公司和欧洲临床营养与代谢学会。版权所有。
Background: To investigate the clinical utility of several established inflammatory, nutritional and tumor markers, and to construct a new scoring system based on preoperative prognostic markers to predict outcomes in gastric cancer (GC).Methods: We retrospectively assessed 688 consecutive patients who underwent curative resection followed by adjuvant chemotherapy for stage II-III GC from 2000 to 2012.Results: On multivariate analysis, C-reactive protein/albumin (CRP/Alb) ratio (>0.2), prognostic nutritional index (PNI) (score 1), preoperative body weight loss (>6%) and carbohydrate antigen 19-9 (CA 19-9) (>27 U/mL) independently predicted unfavorable cancer-specific survival (CSS). These 4 preoperative prognostic markers were allocated 1 point each. Then, a new systemic prognostic score (SPS) was constructed based on the total score. Multivariate analysis revealed that SPS was an independent predictor of CSS (P < 0.001). Patients with a SPS of 0, 1, 2, or 3/4 had a 5-year CSS rates of 67.2%, 45.3%, 29.0%, and 10.6%, respectively (0 vs. 1 [P < 0.001],1 vs. 2 [P = 0.031] and 2 vs. 3/4 [P = 0.004]). The median survival times for SPS 0, SPS 1, SPS 2 and SPS 3/4 were 68.7, 47.1, 28.3 and 16.3 months, respectively. The area under the receiver operating characteristics (ROC) curve for SPS was higher than other markers (P < 0.001). Furthermore, a nomogram that integrated TNM stage, tumor location and SPS exhibited superior discrimination power compared with the TNM stage alone (C-index, 0.714 vs. 0.630, respectively; P < 0.001).Conclusion: The preoperative SPS combining inflammatory, nutritional and tumor markers independently predicted postoperative survival in stage II-III GC patients treated with adjuvant chemotherapy. (C) 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.