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McNamee N, Nindra U, Shahnam A, Yoon R, Asghari R, Ng W, Karikios D, Wong M. Haematological and nutritional prognostic biomarkers for patients receiving CROSS or FLOT. J Gastrointest Oncol 2023; 14:494-503. [PMID: 37201072 PMCID: PMC10186526 DOI: 10.21037/jgo-22-886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/10/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Neoadjuvant carboplatin and paclitaxel with radiotherapy (CROSS) and perioperative docetaxel, oxaliplatin, calcium folinate and fluorouracil (FLOT) are widely used for gastric (GC), gastro-oesophageal junction (GOJ) and oesophageal cancers (OC). Prognostic and predictive markers for response and survival outcomes are lacking. This study evaluates dynamic neutrophil-lymphocyte ratios (NLR), platelet-lymphocyte ratios (PLR), albumin and body mass index (BMI) as predictors of survival, response and toxicity. METHODS This multi-centre retrospective observational study across 5 Sydney hospitals included patients receiving CROSS or FLOT from 2015 to 2021. Haematological results and BMI were recorded at baseline and pre-operatively, and after adjuvant treatment for FLOT. Toxicities were also recorded. An NLR ≥2 and PLR ≥200 was used to stratify patients. Univariate and multivariate analyses were performed to determine predictors of overall survival (OS), disease free survival (DFS), rates of pathological complete response (pCR) and toxicity. RESULTS One hundred sixty-eight patients were included (95 FLOT, 73 FLOT). A baseline NLR ≥2 was predictive for worse DFS (HR 2.78, 95% CI: 1.41-5.50, P<0.01) and OS (HR 2.90, 95% CI: 1.48-5.67, P<0.01). Sustained elevation in NLR was predictive for DFS (HR 1.54, 95% CI: 1.08-2.17, P=0.01) and OS (HR 1.65, 95% CI: 1.17-2.33, P<0.01). An NLR ≥2 correlated with worse pCR rates (16% for NLR ≥2, 48% for NLR <2, P=0.04). A baseline serum albumin <33 was predictive of worse DFS and OS with a HR of 6.17 (P=0.01) and 4.66 (P=0.01) respectively. Baseline PLR, BMI, and dynamic changes in these markers were not associated with DFS, OS or pCR rates. There was no association of the aforementioned variables with toxicity. CONCLUSIONS This demonstrates that a high inflammatory state represented by an NLR ≥2, both at baseline and sustained, is prognostic and predictive of response in patients receiving FLOT or CROSS. Baseline hypoalbuminaemia is predictive of poorer outcomes.
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Affiliation(s)
- Nicholas McNamee
- Department of Medical Oncology, Westmead Hospital, Sydney, Australia
| | - Udit Nindra
- Department of Medical Oncology, Liverpool Hospital, Sydney, Australia
| | - Adel Shahnam
- Department of Medical Oncology, Westmead Hospital, Sydney, Australia
| | - Robert Yoon
- Department of Medical Oncology, Liverpool Hospital, Sydney, Australia
| | - Ray Asghari
- Department of Medical Oncology, Bankstown-Lidcombe Hospital, Sydney, Australia
| | - Weng Ng
- Department of Medical Oncology, Liverpool Hospital, Sydney, Australia
| | - Deme Karikios
- Department of Medical Oncology, Nepean Hospital, Sydney, Australia
| | - Mark Wong
- Department of Medical Oncology, Westmead Hospital, Sydney, Australia
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Li Y, Xu T, Wang X, Jia X, Ren M, Wang X. The prognostic utility of preoperative neutrophil-to-lymphocyte ratio (NLR) in patients with colorectal liver metastasis: a systematic review and meta-analysis. Cancer Cell Int 2023; 23:39. [PMID: 36855112 PMCID: PMC9976405 DOI: 10.1186/s12935-023-02876-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/17/2023] [Indexed: 03/02/2023] Open
Abstract
The neutrophil-to-lymphocyte ratio is used to reflect body's inflammatory status with prognostic value in different cancers. We aimed to investigate the influence of preoperative NLR in the prognosis of CRLM patients receiving surgery using meta-analysis. Data in Cochrane Library, PubMed, Embase, and Web of Science databases created before October 2022 were recruited. Meta-analysis was carried out with RevMan 5.3 and Stata16 software, and the primary outcome indicators included overall survival (OS), and secondary outcome indicators included disease-free survival (DFS) and relapse-free survival (RFS). The pooled risk ratio (HR) and 95% confidence interval (CI) for each outcome indicator were determined using random-effects models or fixed-effects models. The pooled odds ratio (OR) and corresponding 95% confidence intervals (CI) for NLR and clinicopathological characteristics were determined with a fixed-effects model. 18 papers published between 2008 and 2022 (3184 patients in total) were included. The pooled analysis found that high preoperative NLR was correlated with poor OS (multivariate HR = 1.83, 95% CI = 1.61-2.08, p < 0.01), DFS (multivariate HR = 1.78, 95% CI = 1.16-2.71, p < 0.01) and RFS (multivariate HR = 1.46, 95% CI = 1.15-1.85, p < 0.01), but NLR was not related to clinicopathological features of CRLM patients correlation. In conclusion, NLR is an independent risk factor for poor prognosis in patients with CRLM. More large-scale clinical researches are required in the future to demonstrate the inclusion of preoperative NLR as a prognostic indicator for CRLM patients to guide postoperative adjuvant chemotherapy.
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Affiliation(s)
- Yanqing Li
- grid.462400.40000 0001 0144 9297Graduate School of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, 014000 China
| | - Tianxiang Xu
- grid.440229.90000 0004 1757 7789Abdominal Tumor Surgery, Center of Tumor, Inner Mongolia People’s Hospital, Hohhot, 010017 China
| | - Xin Wang
- grid.462400.40000 0001 0144 9297Graduate School of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, 014000 China
| | - Xiangdong Jia
- grid.440229.90000 0004 1757 7789Abdominal Tumor Surgery, Center of Tumor, Inner Mongolia People’s Hospital, Hohhot, 010017 China
| | - Meng Ren
- grid.440229.90000 0004 1757 7789Abdominal Tumor Surgery, Center of Tumor, Inner Mongolia People’s Hospital, Hohhot, 010017 China
| | - Xiaoxia Wang
- Intensive Care Unit, Inner Mongolia People's Hospital, Hohhot, 010017, China.
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Magnin J, Fournel I, Doussot A, Régimbeau JM, Zerbib P, Piessen G, Beyer-Berjot L, Deguelte S, Lakkis Z, Schwarz L, Orry D, Ayav A, Muscari F, Mauvais F, Passot G, Trelles N, Venara A, Benoist S, Messager M, Fuks D, Borraccino B, Trésallet C, Valverde A, Souche FR, Herrero A, Gaujoux S, Lefevre J, Bourredjem A, Cransac A, Ortega-Deballon P. Benefit of a flash dose of corticosteroids in digestive surgical oncology: a multicenter, randomized, double blind, placebo-controlled trial (CORTIFRENCH). BMC Cancer 2022; 22:913. [PMID: 35999521 PMCID: PMC9400297 DOI: 10.1186/s12885-022-09998-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/11/2022] [Indexed: 11/12/2022] Open
Abstract
Background The modulation of perioperative inflammation seems crucial to improve postoperative morbidity and cancer-related outcomes in patients undergoing oncological surgery. Data from the literature suggest that perioperative corticosteroids decrease inflammatory markers and might be associated with fewer complications in esophageal, liver, pancreatic and colorectal surgery. Their benefit on cancer-related outcomes has not been assessed. Methods The CORTIFRENCH trial is a phase III multicenter randomized double-blind placebo-controlled trial to assess the impact of a flash dose of preoperative corticosteroids versus placebo on postoperative morbidity and cancer-related outcomes after elective curative-intent surgery for digestive cancer. The primary endpoint is the frequency of patients with postoperative major complications occurring within 30 days after surgery (defined as all complications with Clavien-Dindo grade > 2). The secondary endpoints are the overall survival at 3 years, the disease-free survival at 3 years, the frequency of patients with intraabdominal infections and postoperative infections within 30 days after surgery and the hospital length of stay. We hypothesize a reduced risk of major complications and a better disease-survival at 3 years in the experimental group. Allowing for 5% of drop-out, 1 200 patients (600 per arm) should be included. Discussion This will be the first trial focusing on the impact of perioperative corticosteroids on cancer related outcomes. If significant, it might be a strong improvement on oncological outcomes for patients undergoing surgery for digestive cancers. Trial registration ClinicalTrials.gov, NCT03875690, Registered on March 15, 2019, URL: https://clinicaltrials.gov/ct2/show/NCT03875690. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09998-z.
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Affiliation(s)
- Joséphine Magnin
- Service de Chirurgie Digestive et Cancérologique, CHU François Mitterrand, 14 rue Paul Gaffarel, 21000 , Dijon, France. .,Department of Digestive Surgical Oncology, University Hospital of Dijon, INSERM 1432, University of Bourgogne, Dijon, France.
| | - Isabelle Fournel
- Department of Clinical Epidemiology, University Hospital of Dijon, INSERM CIC 1432, University of Bourgogne, Dijon, France
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Jean-Marc Régimbeau
- Department of Digestive Surgical Oncology, University Hospital of Amiens, Amiens, France
| | - Philippe Zerbib
- Department of Digestive Surgical Oncology and Liver Transplantation, Claude Huriez University Hospital, Chu Lille, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Chu Lille, France
| | - Laura Beyer-Berjot
- Department of Digestive Surgical Oncology, North University Hospital, Marseille, France
| | - Sophie Deguelte
- Department of Digestive Surgical Oncology, University Hospital of Reims, Reims, France
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Lilian Schwarz
- Department of Digestive Surgical Oncology, University Hospital of Rouen, Rouen, France
| | - David Orry
- Department of Surgical Oncology, Georges François Leclerc Cancer Center, Dijon, France
| | - Ahmet Ayav
- Department of Digestive Surgical Oncology, University Hospital of Nancy, Nancy, France
| | - Fabrice Muscari
- Department of Digestive Surgical Oncology, Rangueil University Hospital, Toulouse, France
| | - François Mauvais
- Department of Digestive Surgery, Simone Veil Hospital, Beauvais, France
| | - Guillaume Passot
- Department of Digestive Surgical Oncology, Pierre Bénite University Hospital, Lyon, France
| | - Nelson Trelles
- Department of Digestive Surgery, René-Dubos Hospital, Cergy-Pontoise, France
| | - Aurélien Venara
- Department of Digestive Surgical Oncology, University Hospital of Angers, Angers, France
| | - Stéphane Benoist
- Department of Digestive Surgical Oncology, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Mathieu Messager
- Department of Digestive Surgery, Gustave Dron Hospital, Tourcoing, France
| | - David Fuks
- Department of Digestive Surgical Oncology, Cochin University Hospital, Paris, France
| | | | - Christophe Trésallet
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Paris, France
| | - Alain Valverde
- Department of Digestive Surgery, La Croix Saint Simon Hospital, Paris, France
| | - François-Régis Souche
- Department of Digestive Surgical Oncology, University Hospital of Montpellier, Montpellier, France
| | - Astrid Herrero
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Montpellier, Montpellier, France
| | - Sébastien Gaujoux
- Department of Digestive Surgical Oncology, Pitié Salpêtrière University Hospital, Paris, France
| | - Jérémie Lefevre
- Department of Digestive Surgical Oncology, Saint-Antoine University Hospital, Paris, France
| | - Abderrahmane Bourredjem
- Department of Clinical Epidemiology, University Hospital of Dijon, INSERM CIC 1432, University of Bourgogne, Dijon, France
| | - Amélie Cransac
- Department of Pharmacy, University Hospital of Dijon, Dijon, France
| | - Pablo Ortega-Deballon
- Service de Chirurgie Digestive et Cancérologique, CHU François Mitterrand, 14 rue Paul Gaffarel, 21000 , Dijon, France.,Department of Digestive Surgical Oncology, University Hospital of Dijon, INSERM 1432, University of Bourgogne, Dijon, France
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Hu L, Liu J, Shimada H, Ito M, Sugimoto K, Hiwasa T, Zhou Q, Li J, Shen S, Wang H. Serum Anti-BRAT1 is a Common Molecular Biomarker for Gastrointestinal Cancers and Atherosclerosis. Front Oncol 2022; 12:870086. [PMID: 35656505 PMCID: PMC9152111 DOI: 10.3389/fonc.2022.870086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/05/2022] [Indexed: 12/23/2022] Open
Abstract
Atherosclerosis (AS) and cancers are major global causes of mortality and morbidity. They also share common modifiable pathogenesis risk factors. As the same strategies used to predict AS could also detect certain cancers, we sought novel serum antibody biomarkers of cancers in atherosclerotic sera sampled by liquid biopsy. Using serological antigen identification by cDNA expression cloning (SEREX) and western blot, we screened and detected the antigens BRCA1-Associated ATM Activator 1 (BRAT1) and WD Repeat Domain 1 (WDR1) in the sera of patients with transient ischemic attacks (TIA). Amplified luminescence proximity homogeneous assay-linked immunosorbent assay (AlphaLISA) established the upregulation of serum BRAT1 antibody (BRAT1-Abs) and WDR1 antibody (WDR1-Abs) in patients with AS-related diseases compared with healthy subjects. ROC and Spearman’s correlation analyses showed that BRAT1-Abs and WDR1-Abs could detect AS-related diseases. Thus, serum BRAT1-Abs and WDR1-Abs are potential AS biomarkers. We used online databases and AlphaLISA detection to compare relative antigen and serum antibody expression and found high BRAT1 and BRAT1-Abs expression in patients with GI cancers. Significant increases (> 0.6) in the AUC for BRAT1-Ab vs. esophageal squamous cell carcinoma (ESCC), gastric cancer, and colorectal cancer suggested that BRAT1-Ab exhibited better predictive potential for GI cancers than WDR1-Ab. There was no significant difference in overall survival (OS) between BRAT1-Ab groups (P = 0.12). Nevertheless, a log-rank test disclosed that the highest serum BRAT1-Ab levels were associated with poor ESCC prognosis at 5–60 weeks post-surgery. We validated the foregoing conclusions by comparing serum BRAT1-Ab and WDR1-Ab levels based on the clinicopathological characteristics of the patients with ESCC. Multiple statistical approaches established a correlation between serum BRAT1-Ab levels and platelet counts. BRAT1-Ab upregulation may enable early detection of AS and GI cancers and facilitate the delay of disease progression. Thus, BRAT1-Ab is a potential antibody biomarker for the diagnosis of AS and GI cancers and strongly supports the routine clinical application of liquid biopsy in chronic disease detection and diagnosis.
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Affiliation(s)
- Liubing Hu
- Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.,The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, China.,College of Life Science and Technology, Jinan University, Guangzhou, China
| | - Jiyue Liu
- Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Anesthesiology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Hideaki Shimada
- Department of Gastroenterological Surgery and Clinical Oncology, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Masaaki Ito
- Department of Gastroenterological Surgery and Clinical Oncology, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Kazuo Sugimoto
- Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Takaki Hiwasa
- Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Qinghua Zhou
- The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, China.,College of Life Science and Technology, Jinan University, Guangzhou, China
| | - Jianshuang Li
- The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, China.,College of Life Science and Technology, Jinan University, Guangzhou, China
| | - Si Shen
- Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Radiology, Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Hao Wang
- Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Anesthesiology, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chiba, Japan
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5
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Lu J, Wu D, Chen S, Huang JB, Xu BB, Xue Z, Zheng HL, Lin GS, Shen LL, Lin J, Zheng CH, Li P, Wang JB, Lin JX, Chen QY, Cao LL, Xie JW, Peng JS, Huang CM. A novel hematological classifier predicting chemotherapy benefit and recurrence hazard for locally advanced gastric cancer A multicenter IPTW analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1768-1777. [DOI: 10.1016/j.ejso.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 01/08/2022] [Accepted: 01/18/2022] [Indexed: 01/19/2023]
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Xie H, Yuan G, Liu M, Huang S, Wei L, Tang S, Gan J. Pretreatment Albumin-to-Fibrinogen Ratio is a Promising Biomarker for Predicting Postoperative Clinical Outcomes in Patients with Colorectal Cancer. Nutr Cancer 2022; 74:2896-2909. [PMID: 35193433 DOI: 10.1080/01635581.2022.2042572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the prognostic value of pretreatment albumin-to-fibrinogen ratio (AFR) in colorectal cancer (CRC). METHODS This retrospective study included 657 CRC patients who underwent surgical resection in 2012-2014. Kaplan-Meier survival curve and Cox proportional hazards model were used to determine independent predictors. Receiver operating characteristic curve analysis was used to assess and compare the ability of indicators to predict survival. RESULTS The optimal cutoff value of AFR was 8.3. Compared with high AFR group, low AFR group had shorter progression-free survival (PFS) (65.32% vs 52.28%, p < 0.001) and overall survival (OS) (67.47% vs 56.14%, p = 0.001). In the stratified analysis of TNM stage, AFR had good prognostic discrimination for early- and advanced-stage patients. Multivariate analysis suggested that AFR was an independent prognostic factor of PFS [hazard ratio (HR) = 1.385, 95% confidence interval (CI) = 1.043-1.839, p = 0.024) and OS (HR = 1.342, 95% CI = 1.022-1.763, p = 0.034) for CRC patients. AFR had better prognostic prediction ability than other inflammation-related markers. The AFR-based nomograms had good predictive capabilities. CONCLUSIONS Pretreatment AFR is an independent prognostic factor for CRC patients undergoing surgical resection and is superior to other established inflammation-related markers.
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Affiliation(s)
- Hailun Xie
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, P.R. China
| | - Guanghui Yuan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, P.R. China
| | - Mingxiang Liu
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, P.R. China
| | - Shizhen Huang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, P.R. China
| | - Lishuang Wei
- Department of Respiratory Medicine, The First Affiliated Hospital, Guangxi Medical University, Nanning, P.R. China
| | - Shuangyi Tang
- Department of Pharmacy, The First Affiliated Hospital, Guangxi Medical University, Nanning, P.R. China
| | - Jialiang Gan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, P.R. China
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Wang C, Zhang X, Lin S, Yang C, Zhou B, Mi Y, Ye R, Chen Y, Chen W, Lin X, Tan S, Zhou Y, Li W. Superiority of Laparoscopic Gastrojejunostomy Combined With Multimodality Therapy for Gastric Outlet Obstruction Caused by Advanced Gastric Cancer. Front Oncol 2022; 12:814283. [PMID: 35155250 PMCID: PMC8832489 DOI: 10.3389/fonc.2022.814283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Data are limited concerning the survival outcomes of patients with gastric outlet obstruction (GOO) caused by advanced gastric cancers according to laparoscopic gastrojejunostomy (LGJ) combined with multimodality therapy (MMT). Therefore, the purpose of this study was to examine the feasibility and efficacy of these therapies. METHODS This single-centered, retrospective analysis included data of 184 patients with GOO due to advanced gastric cancer (AGC). Treatment models were: laparoscopic gastrojejunostomy combined with multimodality therapy (LGJ+MMT), endoscopic metal stent placement combined with multimodality therapy (EMSP+MMT), and multimodality therapy (MMT). RESULTS Improved oral intake, better nutritional indices, and better response to chemotherapy were observed in the LGJ+MMT group. Subsequent gastrectomy was performed in 43 (61.4%) patients in the LGJ+MMT group, 23 (37.7%) in the EMSP+MMT group, and 11 (20.8%) in the MMT group (P<0.001). LGJ+MMT was associated with better long-term prognosis. As confirmed by propensity scores and multivariate analyses, the 3-year survival rates in the three treatment models were 31.4% with LGJ+MMT, 0% with EMSP+MMT, and 0% with MMT in conversion therapy, and 50.0% with LGJ+MMT, 33.3% with EMSP+MMT, and 23.5% with MMT in NAC. A forest plot revealed that LGJ+MMT was related to a decreased risk of death. CONCLUSIONS LGJ combined with MMT was associated with better nutritional status, higher rates of subsequent gastrectomy, and good prognosis. LGJ combined with MMT may improve the long-term survival of patients with GOO caused by AGC.
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Affiliation(s)
- Chuandong Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Xiaojuan Zhang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Radiology, 900th Hospital Logistic Support Forces of PLA, Fuzhou, China
| | - Shengtao Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Changshun Yang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - BiaoHuan Zhou
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Yulong Mi
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Rong Ye
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Yifan Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Weijie Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Xiaojun Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Song Tan
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Yuhang Zhou
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Weihua Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
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Survival Prediction Capabilities of Preoperative Inflammatory and Nutritional Status in Esophageal Squamous Cell Carcinoma Patients. World J Surg 2022; 46:639-647. [PMID: 34999904 DOI: 10.1007/s00268-021-06398-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Studies have revealed the impacts of various inflammatory and nutritional markers in patients with esophageal squamous cell carcinoma (ESCC). We evaluated the prognostic values of multiple inflammation- or nutrition-based markers, either alone or in combination with pStage, in ESCC patients. METHODS In total, 360 patients undergoing upfront surgery for ESCC were retrospectively reviewed. The prognostic capabilities of 7 inflammatory and 3 nutritional parameters were investigated. Furthermore, we devised new staging systems by adding these markers to pStage and examined the prognostic abilities of our new approach. Time-dependent receiver operating characteristic curves and the areas under the curve (AUCs) were estimated to compare prognostic capabilities among the parameters. RESULTS The AUCs for predicting overall survival (OS) of the prognostic nutritional index (PNI), CRP to albumin ration (CAR), lymphocyte to CRP ratio (LCR) and the Naples prognostic score (NPS) were similar to that of pStage. Notably, CAR and LCR showed high predictive capabilities for OS (AUCs; 0.627 and 0.634 for 3-year OS, respectively). New staging systems combining inflammatory or nutritional markers with pStage provided higher AUCs for predicting OS than pStage alone. In particular, NPpStage (NPS and pStage) (P = 0.03), PNpStage (PNI and pStage) (P = 0.03) and LCpStage (LCR and pStage) (P = 0.05) showed significantly higher accuracy for predicting OS than pStage alone. CONCLUSIONS Various inflammatory or nutritional markers, especially those derived from CRP, are useful for predicting survival outcomes of ESCC patients. The predictive capabilities of these indices were augmented when used in combination with pStage.
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Shi L, Wang Z, Wang L, Jia Y, Li J, Qin Y. A Prognostic Nomogram and Heat Map to Predict Survival in Stage II/III Gastric Cancer Patients After Curative Gastrectomy Followed by Adjuvant Chemotherapy. Cancer Manag Res 2022; 14:287-301. [PMID: 35115828 PMCID: PMC8800584 DOI: 10.2147/cmar.s348890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/12/2022] [Indexed: 02/01/2023] Open
Abstract
Purpose This study aimed to study the prognostic value of clinicopathological data, inflammation and nutritional indicators, and to design an effective prognostic nomogram and heat map to predict cancer-specific survival (CSS) and disease-free survival (DFS) of stage II/III GC patients who underwent curative gastrectomy with adjuvant chemotherapy. Patients and Methods We retrospectively analyzed the data of 611 patients with stage II/III GC after curative gastrectomy followed by adjuvant chemotherapy from 3 GC disease centers. Patients were divided into a training cohort (n = 503) and an external validation cohort (n = 108). Nomograms were established based on independent predictors identified by Cox regression analysis in the training cohort. The consistency index (C-index) and the calibration curve were used to evaluate the discriminative ability and accuracy of the nomogram. Heat maps were constructed with the prognostic factors and the corresponding survival probability. We further divided the patients into low-risk and high-risk groups based on the risk score of the nomogram. Results Through univariate and multivariate survival analysis, the independent risk factors common to CSS and DFS were identified. Then these predictors were incorporated into the nomograms, and the established nomograms used to predict CSS and DFS had high discriminative power in the training cohort. Meanwhile, the calibration curves of CSS and DFS probability also showed good agreement between the prediction based on the nomograms and the actual observation results. The above independent predictors were applied to establish heat maps. Compared with low-risk patients, the high-risk patients calculated according to the nomogram had a shorter survival time and a worse prognosis. Conclusion We established a nomogram and heat map, which could be used to assess the survival rate of stage II/III GC patients who underwent curative gastrectomy with adjuvant chemotherapy. These tools had high prognostic prediction accuracy and provided inspiration for clinical decision-making.
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Affiliation(s)
- Litong Shi
- Department of Oncology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Zehua Wang
- Department of Oncology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Lei Wang
- Department of Oncology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Yongxu Jia
- Department of Oncology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Jing Li
- Department of Oncology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Yanru Qin
- Department of Oncology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
- Correspondence: Yanru Qin, Department of Oncology, Zhengzhou University First Affiliated Hospital, No. 1 Jianshe East Road, Erqi District, Zhengzhou, 450052, Henan, People’s Republic of China, Tel +86 13676932999, Email
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10
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Lorton CM, Higgins L, O'Donoghue N, Donohoe C, O'Connell J, Mockler D, Reynolds JV, Walsh D, Lysaght J. C-Reactive Protein and C-Reactive Protein-Based Scores to Predict Survival in Esophageal and Junctional Adenocarcinoma: Systematic Review and Meta-Analysis. Ann Surg Oncol 2021; 29:1853-1865. [PMID: 34773194 DOI: 10.1245/s10434-021-10988-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Esophageal adenocarcinoma (EAC) has a poor prognosis; predictive markers of prognosis would facilitate advances in personalized therapy. C-reactive protein (CRP) and CRP-based scores are increasingly recommended across oncology; however, their role and value in EAC is unclear. This systematic review and meta-analysis examined CRP cut-point and scores and how they may best be applied in predicting survival in EAC. METHODS A systematic literature search was conducted in EMBASE, Medline, Web of Science, Cochrane, Scopus and CINAHL databases, from inception to 1st October 2020. Studies reporting data from adults with EAC including adenocarcinoma of the gastro-esophageal junction (AEG), pre-treatment CRP or CRP-based score and Hazard Ratio (HR) for survival were included. QUIPS tool assessed risk of bias. Meta-analysis was undertaken. RESULTS A total of 819 records were screened. Eight papers were included, with data for 1475 people. CRP cut-points ranged from 2.8 to 10 mg/L. The Glasgow Prognostic Score (GPS) and modified GPS were the most commonly reported scores. On meta-analysis, elevated preoperative GPS/mGPS was significantly associated with worse overall survival (hazards ratio [HR] 1.81, 95% confidence interval [CI] 1.25-2.62, p = 0.002); results were similar in subgroup analyses of multimodal treatment, M0 disease, and R0 resection. CONCLUSIONS This is the first review to evaluate comprehensively the evidence for CRP and CRP-based scores in EAC. Meta-analysis demonstrated that elevated preoperative GPS or mGPS was significantly associated with reduced overall survival in EAC, including AEG. There is insufficient evidence to support use of CRP alone. Future studies should examine GPS/mGPS in EAC prospectively, alone and combined with other prognostic markers.
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Affiliation(s)
- Cliona M Lorton
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland. .,School of Medicine, Trinity College Dublin, Dublin, Ireland. .,Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute, Trinity St. James's Cancer Institute, Trinity College Dublin and St. James's Hospital, Dublin, Ireland.
| | | | | | - Claire Donohoe
- School of Medicine, Trinity College Dublin, Dublin, Ireland.,Gastro-intestinal Medicine and Surgery, St. James's Hospital, Dublin, Ireland.,Department of Surgery, Trinity College Dublin, St James's Hospital, Dublin, Ireland
| | - Jim O'Connell
- School of Medicine, Trinity College Dublin, Dublin, Ireland.,Gastro-intestinal Medicine and Surgery, St. James's Hospital, Dublin, Ireland
| | - David Mockler
- John Stearne Medical Library, Trinity Centre for the Health Sciences, St James's Hospital, Dublin, Ireland
| | - John V Reynolds
- School of Medicine, Trinity College Dublin, Dublin, Ireland.,Gastro-intestinal Medicine and Surgery, St. James's Hospital, Dublin, Ireland.,Department of Surgery, Trinity College Dublin, St James's Hospital, Dublin, Ireland
| | - Declan Walsh
- Department of Supportive Oncology, Levine Cancer Institute, Charlotte, NC, USA
| | - Joanne Lysaght
- School of Medicine, Trinity College Dublin, Dublin, Ireland.,Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute, Trinity St. James's Cancer Institute, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
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11
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Cao X, Cui J, Li Z, Zhao G. Preoperative C-Reactive Protein/Albumin Ratio is a Prognostic Indicator for Survival in Surgically Treated Gastrointestinal Stromal Tumors: A Retrospective Cohort Study. Cancer Manag Res 2021; 13:4155-4167. [PMID: 34079369 PMCID: PMC8163582 DOI: 10.2147/cmar.s307873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background Systemic inflammation and malnutrition may promote tumor progression. C-reactive protein/albumin ratio (CAR) is linked to the poor long-term survival of several malignant tumors. Purpose To explore the predictive value of CAR in gastrointestinal stromal tumors (GISTs). Methods A retrospective study was conducted on 325 patients with primary GIST surgically treated with curative intent from 2009 to 2018. The cut-off point of CAR was set using X-tile software. Kaplan–Meier method and multivariate Cox regression model were used to study the prognostic value of CAR. The time-dependent receiver operating characteristic curve (tROC) was drawn, and the prognostic accuracy of CAR, Glasgow prognostic score (GPS), and National Institute of Health (NIH) risk classification was compared by the area under the curve (AUC). Results The best cut-off point of CAR was 0.55. Increased CAR was associated with the location of the lower digestive tract, larger tumor size, higher mitotic index, higher NIH risk classification, lower ALB, higher CRP, and higher GPS (all p<0.05). Multivariable analysis revealed that CAR (hazard ratio [HR] 2.598, 95% confidence interval [CI] 1.385–4.874; p=0.003) was an independent predictor of overall survival. Additionally, the AUC of CAR was lower than that of NIH risk classification at 2 years (0.601 vs. 0.775, p=0.002) and 5 years (0.629 vs 0.735, p=0.069). However, the AUC of NIH risk classification significantly increased (2-year OS 0.801, p=0.251; 5-year OS 0.777, p=0.011) when combined with CAR. Conclusion CAR is a new independent predictor of poor survival in patients with GIST. CAR combined with NIH risk classification can effectively improve the performance of prognosis prediction.
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Affiliation(s)
- Xianglong Cao
- Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jian Cui
- Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zijian Li
- Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Gang Zhao
- Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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12
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Guo Z, Liang J. Fibrinogen-Albumin Ratio Index (FARI) as a Certain Prognostic Biomarker in Pretreated Patients with Immunotherapy. Cancer Manag Res 2021; 13:4169-4180. [PMID: 34079370 PMCID: PMC8163584 DOI: 10.2147/cmar.s307272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/08/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose Immunotherapy has become the standard treatment for advanced tumors so that many biomarkers play parts in predicting prognosis and clinical outcome. Use of FARI is increasing, but there are no studies on its use prior to immunotherapy. Patients and Methods A retrospective study prior to immunotherapies in advanced carcinoma used FARI and other biomarkers as clinical parameters from which to analyse data from January 2014 to November 2020. Data were presented in GraphPad Prism 7 and X-Tile and analyzed using IBM SPSS. Results A total of 146 patients were enrolled in our study. FARI (with an optimal cut-off value of 11.1%) was divided into a high group, in connection with shorter OS mainly in patients with bone metastasis (120m vs 11.5m, 95% Cl: 12.17–23.83, SE: 2.974, p=0.03), and a low group with a longer PFS (11.0m vs 5.0m, 95% Cl: 3.303–12.697, SE: 2.397, p=0.03) in NSCLC but a shorter PFS (3.5m vs 5.5m, 95% Cl: 3.757–6.243, SE: 0.634, p=0.01) in liver metastasis. FARI was not determined as an independent predictor of OS in patients undergoing medical therapies (>11.1% vs ≤11.1%, HR: 1.296, 95% Cl: 0.687–2.032, p=0.314). ECOG (HR: 2.892, 95% Cl: 1.911–4.378, p<0.001) can be an independent predictor for PFS and OS in advanced carcinoma. Conclusion Our findings highlight certain potential values for predicting prognosis but no outstanding biomarkers prior to immunotherapy according to FARI.
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Affiliation(s)
- Ziwei Guo
- Medical Oncology, Peking University International Hospital, Beijing, People's Republic of China.,Medical Oncology, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Jun Liang
- Medical Oncology, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
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13
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A nomogram combining plasma fibrinogen and systemic immune‑inflammation index predicts survival in patients with resectable gastric cancer. Sci Rep 2021; 11:10301. [PMID: 33986408 PMCID: PMC8119703 DOI: 10.1038/s41598-021-89648-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/29/2021] [Indexed: 12/28/2022] Open
Abstract
Hyperfibrinogenemia and cancer-associated systemic inflammatory response are strongly associated with cancer progression and prognosis. We aimed to develop a novel prognostic score (F-SII score) on the basis of preoperative fibrinogen (F) and systemic immunoinflammatory index (SII), and evaluate its predictive value in patients with resectable gastric cancer (GC). Patients diagnosed with GC between January 2012 and December 2016 were reviewed. The F-SII score was 2 for patients with a high fibrinogen level (≥ 3.37 g/L) and a high SII (≥ 372.8), whereas that for patients with one or neither was 1 or 0, respectively. A high F-SII score was significantly associated with older patient age, a high ASA score, large tumor size, large proportion of perineural invasion, and late TNM stage. Multivariate analysis indicated that the F-SII score, histological grade, and TNM stage were independent factors for overall survival (OS). The Harrell's concordance index (C-index) of a nomogram based on the F-SII score and several clinicopathological manifestations was 0.72, which showed a better predictive ability for OS than the TNM stage alone (0.68). In conclusion, preoperative F-SII may serve as a useful predictive factor for OS and refine outcome prediction for patients with resectable GC combined with traditional clinicopathological analysis.
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14
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Chen C, Liu Y, Han P, Cui B. Research Progress of Preoperative FPR, FAR or AFR in Patients with Colorectal Cancer. Cancer Manag Res 2021; 13:1791-1801. [PMID: 33654428 PMCID: PMC7910077 DOI: 10.2147/cmar.s292605] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/03/2021] [Indexed: 12/12/2022] Open
Abstract
Research has confirmed that plasma albumin (Alb), prealbumin (PA) and fibrinogen (Fib) are involved in regulating the occurrence and development of various tumors. Their levels in peripheral blood are related to the survival outcome and treatment response of patients, but the accuracy and specificity of single application have yet to be fully realized. A growing amount of evidence indicates that predictors such as preoperative fibrinogen to prealbumin ratio (FPR), fibrinogen to albumin ratio (FAR) or albumin to fibrinogen ratio (AFR) are emerging as comprehensive indicators. Indeed, their components play a key regulatory role in the progression of colorectal cancer (CRC). Preoperative FPR, FAR or AFR levels, therefore, are expected to become new biomarkers for prognosis evaluation and curative effect prediction for CRC patients and are significant in the guidance they could provide for the development of individualized treatment strategies.
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Affiliation(s)
- Chen Chen
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Yanlong Liu
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Peng Han
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Binbin Cui
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang Province, People's Republic of China
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15
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Duman D, Sonkaya E, Yıldırım E, Gıdık E, Tanülkü U, Saltürk C, Karakurt Z. Association of Inflammatory Markers with Mortality in Patients Hospitalized with Non-massive Pulmonary Embolism. Turk Thorac J 2021; 22:24-30. [PMID: 33646100 DOI: 10.5152/turkthoracj.2021.190076] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 02/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Pulmonary embolism (PE) is a serious pathology with high rates of morbidity and mortality. Studies regarding the efficacy of new inflammatory markers as a predictor of mortality in PE have thus far been limited. This study aimed to evaluate the predictive value of platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), platelet/mean platelet volume (PLT/MPV), and C-reactive protein (CRP) on short-term and long-term mortality in patients with PE. MATERIAL AND METHODS A retrospective, observational cohort study was carried out in a tertiary teaching hospital. Patients with PE hospitalized in the pulmonology ward were enrolled. Their characteristics, hemogram parameters, PLR, NLR, CRP levels, PLT/MPV on admission, and mortality were recorded. The predictive accuracies of inflammatory markers were determined through receiver operating characteristic curves. The risk factors for mortality were further analyzed with Cox regression analysis. RESULTS A total of 828 patients with PE were included in the study. The 1-month mortality was 1%, and the 1-year mortality was 8.5%. An NLR value above 6 was associated with an almost 13-fold increase in short-term (30-day) mortality. We found that an NLR above 3.15 and age were independent risk factors for long-term (1-year) mortality. The other inflammatory markers, namely PLR and CRP, were not found to be associated with long-term mortality. CONCLUSION PE is a serious condition in the elderly. Elevated NLR values appear to be a good and feasible predictor of inflammation, which can be correlated with higher mortality over both the short-term and long-term periods.
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Affiliation(s)
- Dildar Duman
- Department of Chest Diseases, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Esin Sonkaya
- Department of Chest Diseases, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Elif Yıldırım
- Department of Chest Diseases, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Erman Gıdık
- Department of Chest Diseases, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Uğurcan Tanülkü
- Department of Chest Diseases, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Cüneyt Saltürk
- Department of Chest Diseases, Gaziosmanpasa Hospital of Yeni Yüzyıl University, İstanbul, Turkey
| | - Zuhal Karakurt
- Department of Chest Diseases, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
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16
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Gao X, Pan Y, Han W, Hu C, Wang C, Chen L, Guo Y, Shi Y, Pan Y, Xie H, Yao L, Yang J, Zheng J, Li X, Liu X, Hong L, Li J, Li M, Ji G, Li Z, Xia J, Zhao Q, Fan D, Wu K, Nie Y. Association of systemic inflammation and body mass index with survival in patients with resectable gastric or gastroesophageal junction adenocarcinomas. Cancer Biol Med 2021; 18:283-297. [PMID: 33628601 PMCID: PMC7877168 DOI: 10.20892/j.issn.2095-3941.2020.0246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/18/2020] [Indexed: 12/20/2022] Open
Abstract
Objective The systemic inflammation index and body mass index (BMI) are easily accessible markers that can predict mortality. However, the prognostic value of the combined use of these two markers remains unclear. The goal of this study was therefore to evaluate the association of these markers with outcomes based on a large cohort of patients with gastric cancer. Methods A total of 2,542 consecutive patients undergoing radical surgery for gastric or gastroesophageal junction adenocarcinoma between 2009 and 2014 were included. Systemic inflammation was quantified by the preoperative neutrophil-to-lymphocyte ratio (NLR). High systemic inflammation was defined as NLR ≥ 3, and underweight was defined as BMI < 18.5 kg/m2. Results Among 2,542 patients, NLR ≥ 3 and underweight were common [627 (25%) and 349 (14%), respectively]. In the entire cohort, NLR ≥ 3 or underweight independently predicted overall survival (OS) [hazard ratio (HR): 1.236, 95% confidence interval (95% CI): 1.069-1.430; and HR: 1.600, 95% CI: 1.350-1.897, respectively] and recurrence-free survival (RFS) (HR: 1.230, 95% CI: 1.054-1.434; and HR: 1.658, 95% CI: 1.389-1.979, respectively). Patients with both NLR ≥ 3 and underweight (vs. neither) had much worse OS (HR: 2.445, 95% CI: 1.853-3.225) and RFS (HR: 2.405, 95% CI: 1.802-3.209). Furthermore, we observed similar results in subgroup analyses according to pathological stage, age, and postoperative chemotherapy. Conclusions Our results showed that preoperative elevated NLR and decreased BMI had a significant negative effect on survival. Underweight combined with severe inflammation could enhance prognostication. Taking active therapeutic measures to reduce inflammation and increase nutrition may help improve outcomes.
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Affiliation(s)
- Xianchun Gao
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
| | - Yanan Pan
- School of Life Science, Northwest University, Xi'an 710069, China
| | - Weili Han
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
| | - Caie Hu
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710021, China
| | - Chenchen Wang
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
| | - Ling Chen
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Air Force Medical University of PLA, Xi'an 710032, China
| | - Yong Guo
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Air Force Medical University of PLA, Xi'an 710032, China
| | - Yupeng Shi
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
| | - Yan Pan
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
| | - Huahong Xie
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
| | - Liping Yao
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
| | - Jianjun Yang
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
| | - Jianyong Zheng
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
| | - Xiaohua Li
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
| | - Xiaonan Liu
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
| | - Liu Hong
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
| | - Jipeng Li
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
| | - Mengbin Li
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
| | - Gang Ji
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
| | - Zengshan Li
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Air Force Medical University of PLA, Xi'an 710032, China
| | - Jielai Xia
- Department of Medical Statistics, School of Preventive Medicine, Air Force Medical University of PLA, Xi'an 710032, China
| | - Qingchuan Zhao
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
| | - Daiming Fan
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
| | - Kaichun Wu
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
| | - Yongzhan Nie
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Medical University of PLA, Xi'an 710032, China
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17
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Gu L, Wang M, Cui X, Mo J, Yuan L, Mao F, Zhang K, Ng DM, Chen P, Wang D. Clinical significance of peripheral blood-derived inflammation markers in advanced gastric cancer after radical resection. BMC Surg 2020; 20:219. [PMID: 33008382 PMCID: PMC7532590 DOI: 10.1186/s12893-020-00884-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/24/2020] [Indexed: 01/19/2023] Open
Abstract
Background The prognostic significance of peripheral blood-derived inflammation markers in patients with gastric cancer (GC) has not been elucidated. This study aimed to investigate the relationship between systemic inflammatory markers and GC prognosis. Methods A prospective observational cohort study involving 598 patients was conducted to analyze the prognosis of GC based on systemic inflammatory markers. The following peripheral blood-derived inflammation markers were evaluated: the neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), systemic immune-inflammation index (SII), C-reactive protein/albumin (CRP/Alb) ratio, Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), prognostic nutrition index (PNI), and prognostic index (PI). The receiver operating characteristics (ROC) curve and the Youden index were used to determine the optimal cutoff values. Univariate and multivariate analysis of prognostic factors was conducted accordingly. Results The optimal cutoff values of the PNI, fibrinogen, NLR, PLR, SII, and CRP/Alb were 49.5, 397 ng/dl, 2.5, 154, 556, and 0.05, respectively. Multivariate analysis showed that age, PLR, TNM stage, and chemotherapy were the independent prognostic factors for advanced gastric cancer (AGC). Adjuvant chemotherapy improved the long-term prognosis of patients with PLR ≥154, but chemotherapy had no significant effect on the survival of patients with PLR < 154. Conclusions Our findings show that higher PLR (≥154) is an independent risk factor for poor prognosis in GC patients. Besides, PLR can predict adjuvant chemotherapy (oxaliplatin/5-fluorouracil combination) response in patients with GC after surgery.
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Affiliation(s)
- Lihu Gu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, Zhejiang, China.,Ningbo Clinical Research Center for Digestive System Tumors, Ningbo, Zhejiang, China
| | - Mian Wang
- Infection Department, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
| | - Xuena Cui
- Intensive Care Unit, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
| | - Jiahang Mo
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Lingling Yuan
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Feiyan Mao
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Kang Zhang
- Medical College of Ningbo University, Ningbo, Zhejiang, China
| | - Derry Minyao Ng
- Medical College of Ningbo University, Ningbo, Zhejiang, China
| | - Ping Chen
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Dongjie Wang
- Department of Clinical Laboratory, HwaMei Hospital, University of Chinese Academy of Sciences, Northwest Street 41, Haishu District, Ningbo, 315010, Zhejiang, China.
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18
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Xie H, Yuan G, Huang S, Kuang J, Yan L, Ruan G, Tang S, Gan J. The prognostic value of combined tumor markers and systemic immune-inflammation index in colorectal cancer patients. Langenbecks Arch Surg 2020; 405:1119-1130. [PMID: 32794068 DOI: 10.1007/s00423-020-01963-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/09/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE This study evaluated the significance of combining tumor markers (TM) and systemic immune-inflammation index (SII) for postoperative complications and long-term outcomes in colorectal cancer (CRC) patients. METHODS CRC patients (662) who underwent surgery between 2012 and 2014 were retrospectively enrolled into our study. Factors affecting postoperative complications were evaluated by logistic regression analysis. Prognostic factors were assessed using Kaplan-Meier and Cox proportional hazards models. Nomograms were constructed to predict the risk of postoperative complications and survival. A consistency index and a calibration curve were used to evaluate the predictive accuracy of nomograms. RESULTS TM-SII score was established by combining TM and SII. Logistic regression analyses showed that TM-SII score was an important predictor of postoperative complications in CRC patients. Kaplan-Meier analyses showed that TM-SII score was favorable for prognostic risk stratification. In addition, multivariate analyses indicated that TM-SII score was an independent prognostic indicator for disease-free survival and overall survival. TM-SII based nomograms had a moderate prediction accuracy. CONCLUSION TM-SII score is a good prognostic indicator for CRC patients. It may be used as a useful risk stratification tool for advanced CRC patients. TM-SII-based nomograms could be used to identify CRC patients with poor outcomes.
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Affiliation(s)
- Hailun Xie
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Guanghui Yuan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Shizhen Huang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Jiaan Kuang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Ling Yan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Guotian Ruan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Shuangyi Tang
- Deparment of Pharmacy, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Jialiang Gan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
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Feng LW, Li J, Liang LF, Guo QQ, Li J, Wu J, Zhang PH, Qin YR. A Predictive Scoring System Based on Inflammatory and Tumor Markers for Gastric Cancer Patients Undergoing Curative Resection. Cancer Manag Res 2020; 12:3937-3948. [PMID: 32547229 PMCID: PMC7263882 DOI: 10.2147/cmar.s250408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/06/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose Inflammation is closely associated with prognosis in gastric cancer (GC). We aimed to assess the predictive value of existing inflammatory and tumor markers in GC, to establish a systemic score based on valuable predictors for early risk stratification of patients, and to create a nomogram for individual risk prediction. Patients and Methods We retrospectively analyzed 401 GC patients who underwent curative gastrectomy from 2007 to 2016. Results Through univariate and multivariate survival analysis, age (>60 years), depth of invasion (pT3–4), lymph node invasion (pN1–3), histologic classification (poor), adjuvant chemotherapy (no), albumin fibrinogen ratio (AFR) (<13.33), and carbohydrate antigen 19-9 (CA19-9) (>27 U/mL) independently indicated inferior disease-free survival (DFS). In addition, depth of invasion, lymph node invasion, histologic classification, adjuvant chemotherapy, AFR, and CA19-9 were incorporated in the prediction of cancer-specific survival (CSS). A combined AFR and CA19-9 prognostic score (CACPS) was established. Lower AFR (<13.33) and higher CA19-9 (>27 U/mL) were allocated 1 point each in the CACPS (range, 0–2). CACPS can be used as an independent predictor for DFS and CSS in multivariate analysis (for DFS: CACPS 1: HR=2.039, 95% CI: 1.357–3.065, P=0.001; CACPS 2: HR=2.419, 95% CI: 1.397–4.186, P=0.002; for CSS: CACPS 1: HR=2.035, 95% CI: 1.292–3.205, P=0.002; CACPS 2: HR=2.255, 95% CI: 1.252–4.059, P=0.007), with a higher CACPS indicating poor survival according to Kaplan–Meier curves (both P<0.001). Moreover, a nomogram for DFS and CSS was generated using the significant characteristics in the multivariate analysis, which exhibited high accuracy (for DFS: C-index=0.743, 95% CI: 0.698–0.788; for CSS: C-index=0.766, 95% CI: 0.718–0.814) versus tumor–node–metastasis staging (for DFS: C-index=0.692, 95% CI: 0.650–0.734; for CSS: C-index=0.720, 95% CI: 0.675–0.764). Conclusion Preoperative CACPS exhibited high accuracy in predicting prognosis for GC patients who underwent curative resection.
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Affiliation(s)
- Li-Wen Feng
- Department of Oncology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, People's Republic of China
| | - Jing Li
- Department of Oncology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, People's Republic of China
| | - Li-Feng Liang
- Department of Internal Medicine, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, People's Republic of China
| | - Qian-Qian Guo
- Department of Oncology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, People's Republic of China
| | - Jiang Li
- Preventive Medicine, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Jian Wu
- Preventive Medicine, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Pei-Hua Zhang
- Preventive Medicine, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yan-Ru Qin
- Department of Oncology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, People's Republic of China
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Sugawara K, Yagi K, Uemura Y, Okumura Y, Nishida M, Aikou S, Yamashita H, Seto Y. Associations of Systemic Inflammation and Sarcopenia With Survival of Esophageal Carcinoma Patients. Ann Thorac Surg 2020; 110:374-382. [PMID: 32278754 DOI: 10.1016/j.athoracsur.2020.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 02/25/2020] [Accepted: 03/02/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although both sarcopenia and systemic inflammation reportedly affect long-term outcomes of esophageal carcinoma (EC) patients, their reciprocal associations with survival outcomes have yet to be investigated. This study aimed to evaluate the survival impact of sarcopenia combined with the neutrophil-to-lymphocyte ratio (NLR) in EC patients undergoing esophagectomy. METHODS In total, 378 EC patients were retrospectively reviewed. The cutoff value for NLR was set at the NLR median of the cohort. Sarcopenia was determined based on decreased skeletal muscle index calculated from computed tomography obtained before surgery. Univariate and multivariate Cox hazards models were applied to determine independent predictors of poor overall survival and cancer-specific survival. RESULTS Sarcopenia was more common in the high-NLR group (2.57 or greater) than in the low-NLR group (less than 2.57; P = .01). In the high-NLR group, patients with sarcopenia had significantly poorer overall and cancer-specific survival than those without sarcopenia (P < .001). In contrast, there was no survival impact of sarcopenia in the low-NLR group. Patients with both high NLR and sarcopenia exhibited poor overall and cancer-specific survival (5-year overall survival = 44.4%, 5-year cancer-specific survival = 57.0%). Sarcopenia was independently associated with poor overall survival (hazard ratio = 1.95; P = .007) and poor cancer-specific survival (hazard ratio = 2.66; P = .002) as well as pathological stage III disease and noncurative resection in the high-NLR group. CONCLUSIONS The survival and oncological impact of sarcopenia was noteworthy only when present with elevated NLR. The combination of 2 factors is rational for identifying EC patients likely to have poor survival outcomes.
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Affiliation(s)
- Kotaro Sugawara
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yukari Uemura
- Biostatistics Section, Department of Data Science, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuhiro Okumura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masato Nishida
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Susumu Aikou
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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21
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Liu CT, Hong CQ, Huang XC, Li EM, Xu YW, Peng YH. Blood-based Markers in the Prognostic Prediction of Esophagogastric Junction Cancer. J Cancer 2020; 11:4332-4342. [PMID: 32489452 PMCID: PMC7255356 DOI: 10.7150/jca.44545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/13/2020] [Indexed: 02/05/2023] Open
Abstract
Esophagogastric junction cancer poses a great threat to human beings both in western countries and East Asia, especially in China and Japan, and its incidence has increased during recent decades. The 5-year survival rate of esophagogastric junction cancer is quite poor compared with that of other gastric cancer sites. Until now, the traditional TNM staging system has been widely used in clinical practice for prognosis. However, the TNM system is based on pathology after surgical resection or radiology using CT and MRI, not on blood markers. Evidently, some research has been reported concentrated on the prognostic value of blood-based markers with the character of non-invasive and non-radioactive in EJA. Hematologic, biochemical and coagulation parameters could be obtained from clinical data and utilized to analyze their prognostic values. Tumor-associated antigens, microRNAs and circulating tumor cells have also been reported in EJC prognosis. In this article, we review research focused on blood-based markers to evaluate their prognostic value in esophagogastric junction cancer, especially its main subtype adenocarcinoma.
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Affiliation(s)
- Can-Tong Liu
- Department of Clinical Laboratory Medicine, the Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, Guangdong, China
| | - Chao-Qun Hong
- Department of Oncological Laboratory Research, the Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xu-Chun Huang
- Department of Clinical Laboratory Medicine, the Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, Guangdong, China
| | - En-Min Li
- Department of Biochemistry and Molecular Biology, Shantou University Medical College, Shantou, Guangdong, China
| | - Yi-Wei Xu
- Department of Clinical Laboratory Medicine, the Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, Guangdong, China
- ✉ Corresponding authors: Yu-Hui Peng, Department of Clinical Laboratory Medicine, the Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou 515041, Guangdong, China. E-mail: ; Telephone: +86-137-1591-2739; Fax: +86-754-8856-0352. Also correspondence to Yi-Wei Xu,
| | - Yu-Hui Peng
- Department of Clinical Laboratory Medicine, the Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, Guangdong, China
- ✉ Corresponding authors: Yu-Hui Peng, Department of Clinical Laboratory Medicine, the Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou 515041, Guangdong, China. E-mail: ; Telephone: +86-137-1591-2739; Fax: +86-754-8856-0352. Also correspondence to Yi-Wei Xu,
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22
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Sarı R, Karakurt Z, Ay M, Çelik ME, Yalaz Tekan Ü, Çiyiltepe F, Kargın F, Saltürk C, Yazıcıoğlu Moçin Ö, Güngör G, Adıgüzel N. Neutrophil to lymphocyte ratio as a predictor of treatment response and mortality in septic shock patients in the intensive care unit. Turk J Med Sci 2019; 49:1336-1349. [PMID: 31648506 PMCID: PMC7018205 DOI: 10.3906/sag-1901-105] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/12/2019] [Indexed: 12/11/2022] Open
Abstract
Background/aim While C-reactive protein (CRP) is a well-studied marker for predicting treatment response and mortality in sepsis, it was aimed to assess the efficacy of the neutrophil lymphocyte ratio (NLR) as a predictor of mortality and treatment response in sepsis patients in the intensive care unit (ICU). Materials and methods In this retrospective cross-sectional study, sepsis patients were divided according to the presence of septic shock on the 1st day of ICU stay, and then subgrouped according to mortality. Patient demographics, acute physiologic and chronic health evaluation II and sequential organ failure assessment scores, NLR and CRP (on the 1st, 3rd, and last day in the ICU), microbiology data, antibiotic responses, ICU data, and mortality were recorded. Receiver operating characteristic (ROC) curves for the area under curve (AUC) were calculated for the inflammatory markers and ICU severity scores for mortality. Results Of the 591 (65% male) enrolled patients, 111 (18.8%) were nonsurvivors with shock, 117 (19.8%) were survivors with shock, 330 (55.8%) were survivors without shock, and 33 (5.6%) were nonsurvivors without shock. On the 1st day of ICU stay, the NLR and CRP were similar in all of the groups. On the 3rd day of antibiotic response, the NLR was increased (11.8) in the nonresponsive patients when compared with the partially responsive (11.0) and responsive (8.5) patients. If the NLR was ≥15 on the 3rd day, the mortality odds ratio was 6.96 (CI: 1.4–34.1, P < 0.017). The NLR and CRP on the 1st, 3rd, and last day of ICU stay (0.52, 0.58, 0.78 and 0.56, 0.70, 0.78, respectively) showed a similar increasing trend for mortality. Conclusion The NLR can predict mortality and antibiotic responsiveness in ICU patients with sepsis and septic shock. If the NLR is >15 on the 3rd day of postantibiotic initiation, the risk of mortality is high and treatment should be reviewed carefully.
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Affiliation(s)
- Rabia Sarı
- Department of Intensive Care, Hatay State Hospital, Hatay, Turkey
| | - Zuhal Karakurt
- Department of Intensive Care, University of Health Sciences Süreyyapaşa Chest Diseases and Thoracic Surgery Research and Training Hospital, İstanbul, Turkey
| | - Mustafa Ay
- Department of Intensive Care, Batman Regional Hospital, Batman, Turkey
| | - Muhammed Emin Çelik
- Department of Intensive Care, Ahi Evran Thoracic and Cardiovascular Surgery Hospital, Trabzon, Turkey
| | - Ülgen Yalaz Tekan
- Department of Neurology, Şişli Hamidiye Etfal Research and Training Hospital, İstanbul, Turkey
| | - Fulya Çiyiltepe
- Department of Intensive Care, İstanbul Dr. Lütfi Kırdar Research and Training Hospital, İstanbul, Turkey
| | - Feyza Kargın
- Department of Intensive Care, University of Health Sciences Süreyyapaşa Chest Diseases and Thoracic Surgery Research and Training Hospital, İstanbul, Turkey
| | - Cünyet Saltürk
- Department of Intensive Care, University of Health Sciences Süreyyapaşa Chest Diseases and Thoracic Surgery Research and Training Hospital, İstanbul, Turkey
| | - Özlem Yazıcıoğlu Moçin
- Department of Intensive Care, University of Health Sciences Süreyyapaşa Chest Diseases and Thoracic Surgery Research and Training Hospital, İstanbul, Turkey
| | - Gökay Güngör
- Department of Intensive Care, University of Health Sciences Süreyyapaşa Chest Diseases and Thoracic Surgery Research and Training Hospital, İstanbul, Turkey
| | - Nalan Adıgüzel
- Department of Intensive Care, University of Health Sciences Süreyyapaşa Chest Diseases and Thoracic Surgery Research and Training Hospital, İstanbul, Turkey
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23
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Wang YY, Liu ZZ, Xu D, Liu M, Wang K, Xing BC. Fibrinogen-Albumin Ratio Index (FARI): A More Promising Inflammation-Based Prognostic Marker for Patients Undergoing Hepatectomy for Colorectal Liver Metastases. Ann Surg Oncol 2019; 26:3682-3692. [PMID: 31264117 DOI: 10.1245/s10434-019-07586-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Systemic inflammation response is involved in the development and progression of cancers. This study aimed to evaluate the prognostic value of a preoperative Fibrinogen-Albumin Ratio Index (FARI) in patients undergoing hepatectomy for colorectal liver metastases (CRLM) and compare it with established systemic inflammation markers, including the neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, and systemic immune-inflammation index. METHODS Patients who underwent hepatectomy for CRLM between November 2002 and December 2016 were considered for inclusion. Time-dependent receiver operating characteristic (ROC) curve analysis was conducted to evaluate the ability of markers in predicting survival. Multivariable Cox regression analysis was used to identify independent predictors for overall survival (OS) or disease-free survival (DFS). RESULTS A total of 452 consecutive patients were enrolled. The areas under the ROC curve of the FARI in predicting OS and DFS were superior to other inflammatory markers and carcinoembryonic antigen (CEA). The optimal cut-off value of the FARI was 7.6%. Patients with a high FARI (> 7.6%) showed significantly decreased OS and DFS (all p < 0.001). In multivariable analysis, the FARI was the only inflammatory marker that independently predicted OS and DFS. Additionally, regardless of patients having a high or low CEA, the FARI further stratified these patients into subgroups with significantly distinct OS and DFS (all p < 0.05). The FARI also showed good clinical utility in patients with different clinical characteristics. CONCLUSIONS A preoperative FARI is an independent predictor of OS and DFS for patients undergoing hepatectomy for CRLM, superior to the established systemic inflammation markers and CEA.
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Affiliation(s)
- Yan-Yan Wang
- Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Zhen-Zhen Liu
- Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Da Xu
- Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Ming Liu
- Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Kun Wang
- Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Bao-Cai Xing
- Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Haidian District, Beijing, China.
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24
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Evans LA, Tansey C, Wiebe M, Sloan CQ, Patlogar JE, Northcutt S, Murphy LA, Nakamura RK. A prospective evaluation of rivaroxaban on haemostatic parameters in apparently healthy dogs. Vet Med Sci 2019; 5:317-324. [PMID: 30848104 PMCID: PMC6682794 DOI: 10.1002/vms3.161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The purpose of this study was to determine the effect of rivaroxaban (RIV) on haemostatic parameters assessed by prothrombin time (PT), activated partial thromboplastin time (aPTT) and kaolin‐activated thromboelastography (TEG) in apparently healthy dogs administered 1 mg kg−1 orally once daily for 1 week. Eleven dogs had a baseline complete blood count (CBC), fibrinogen, platelet count, serum chemistry profile, PT, aPTT, and TEG performed. Each dog was then administered approximately 1.0 mg kg−1 of RIV orally once daily for 1 week and the CBC, fibrinogen, platelet count, serum chemistry profile, PT, aPTT, and TEG was re‐evaluated. Any side effects attributed to RIV were noted at this time. One dog was excluded due to identification of a macrocytic thrombocytopenia on pre‐treatment blood work. The remaining 10 enrolled dogs completed the study. Dogs received a median dose of 1.02 mg kg−1 (range 0.94–1.17 mg kg−1) of RIV once daily and was associated with a significant increase in pulse, packed cell volume, total solids, platelet count, fibrinogen and a significant decrease in mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration. There was no significant change in PT, aPTT or any TEG parameters. The RIV appeared well tolerated with one dog having one episode of vomiting on day 4 but otherwise no other side effects were identified clinically or on recheck blood work. The results of this study suggests that RIV at a dose of 1 mg kg−1 orally once daily is safe and well tolerated but does not cause a significant prolongation of PT, aPTT or TEG parameters.
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Affiliation(s)
- Liam A Evans
- Inland Valley Veterinary Specialists and Emergency Center, Upland, California, USA
| | - Colleen Tansey
- Inland Valley Veterinary Specialists and Emergency Center, Upland, California, USA
| | - Melissa Wiebe
- Inland Valley Veterinary Specialists and Emergency Center, Upland, California, USA
| | | | - Jeffrey E Patlogar
- Inland Valley Veterinary Specialists and Emergency Center, Upland, California, USA
| | - Sarah Northcutt
- Inland Valley Veterinary Specialists and Emergency Center, Upland, California, USA
| | - Lisa A Murphy
- Veterinary Specialty Center of Delaware, New Castle, Delaware, USA
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Preoperative Serum Platelet-Lymphocyte Ratio as a Prognostic Factor in Cholangiocarcinoma Patients after Radical Resection: A Retrospective Analysis of 119 Patients. Gastroenterol Res Pract 2019; 2019:8506967. [PMID: 30809257 PMCID: PMC6369483 DOI: 10.1155/2019/8506967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/22/2018] [Accepted: 12/16/2018] [Indexed: 12/13/2022] Open
Abstract
Aims Although prognostic markers are important to establish therapeutic strategies in patients for conducting radical resection of cholangiocarcinoma (CCA), there is still a lack of simple, valid, and repeatable markers in clinical settings. We aim to evaluate the prognostic value of the preoperative serum platelet-lymphocyte ratio (PLR) in CCA patients who underwent radical resection. Methods We retrospectively analyzed CCA patients who underwent radical resection surgery in our institution from January 2011 to June 2016. Baseline PLR and other clinical pathological data were measured when patients were diagnosed initially. The prognostic value of PLR in overall survival (OS) and progression-free survival (PFS) were analyzed with the Cox proportional hazard model and the Kaplan–Meier method. Results This study retrospectively analyzed 119 patients who underwent radical resection of CCA. During a median follow-up time of 11.0 months, there were 99.2% recurrences and 42.9% who died, and the median OS and PFS were 9.4 months and 7.4 months, respectively. Multivariate Cox analysis identified that elevated levels of PLR (PLR > 157.25) as a significant factor predicted poorer OS (P = 0.018, HR: 2.160, 95% CI: 1.139-4.096) and PFS (P = 0.005, HR: 1.930, 95% CI: 1.220-3.053). In subgroup analysis, PLR also effectively predicted OS (P = 0.016, HR: 2.515, 95% CI: 1.143-5.532) and PFS (P = 0.042, HR: 1.908, 95% CI: 0.982-3.713) in CCA patients with positive lymphatic metastasis and/or positive surgical margin who required adjuvant therapy. Conclusions The preoperative serum PLR is an independent prognostic factor for OS and PFS in CCA patients after radical resection, including patients requiring adjuvant therapy.
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Lin Y, Liu Z, Qiu Y, Zhang J, Wu H, Liang R, Chen G, Qin G, Li Y, Zou D. Clinical significance of plasma D-dimer and fibrinogen in digestive cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2018; 44:1494-1503. [DOI: 10.1016/j.ejso.2018.07.052] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/23/2018] [Indexed: 12/20/2022] Open
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Wen J, Bedford M, Begum R, Mitchell H, Hodson J, Whiting J, Griffiths E. The value of inflammation based prognostic scores in patients undergoing surgical resection for oesophageal and gastric carcinoma. J Surg Oncol 2018; 117:1697-1707. [PMID: 29761518 DOI: 10.1002/jso.25057] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/08/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Surgical interventions for oesophagogastric cancer carry a significant burden of morbidity and mortality. A range of inflammation based prognostic scores have been proposed in an attempt to predict outcome. This study evaluated five such prognostic scores in oesophageal and gastric carcinoma patients. METHODS The modified Glasgow Prognostic Score (mGPS), Neutrophil Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR), Prognostic Index (PI), and Prognostic Nutrition Index (PNI) were calculated for 723 consecutive patients undergoing oesophagectomy or gastrectomy at a single center. The predictive accuracy of each score was assessed using ROC curves and survival analyses. RESULTS Overall, only PLR and PNI were significantly predictive of patient survival (both P < 0.001), with no significant association detected for mGPS (P = 0.480), NLR (P = 0.210), or PI (P = 0.808). Subgroup analysis found the predictive accuracy of PNI to be significantly greater in oesophagectomy than gastrectomy patients (hazard ratio 2.75 vs 1.39, P = 0.016) and mGPS to be predictive of patient survival only in oesophagectomies (P < 0.001). CONCLUSIONS Inflammation based prognostic scores may have a role in patients undergoing resection for oesophageal and gastric cancer. These scores are easily calculable from routinely collected data and could be used as an adjunct to existing staging modalities.
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Affiliation(s)
- Jiaxin Wen
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Matthew Bedford
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - James Hodson
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - John Whiting
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ewen Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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28
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Deng J, Zhang P, Sun Y, Peng P, Huang Y. Prognostic and clinicopathological significance of platelet to lymphocyte ratio in esophageal cancer: a meta-analysis. J Thorac Dis 2018; 10:1522-1531. [PMID: 29707302 DOI: 10.21037/jtd.2018.02.58] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The prognostic and clinicopathological significance of the platelet to lymphocyte ratio (PLR) has been studied in various cancers. However, studies examining the role of PLR in esophageal cancer have not yielded consistent results. The purpose of this meta-analysis was to study the prognostic and clinicopathological significance of PLR in esophageal cancer patients. Methods We performed a literature search in three major databases: PubMed, Web of Science and Embase (up until May 1, 2017). The clinicopathologic significance of PLR and its prognostic significance were analyzed. Results Our meta-analysis consisted of 13 studies with 4,621 patients. The pooled hazard ratios (HRs) showed that a high PLR was associated with poor survival of esophageal cancer [HR =1.283; 95% confidence interval (CI): 1.173-1.404; P<0.001]. Subgroup analysis revealed that elevated PLR was associated with poor survival in esophageal squamous cell carcinoma (HR =1.281; 95% CI: 1.098-1.493; P=0.002). The pooled odds ratio (OR) indicated that high PLR was also associated with the depth of tumor invasion (OR =1.543, 95% CI: 1.269-1.876, P<0.001), lymph node metastasis (OR =1.427, 95% CI: 1.195-1.705, P<0.001), tumor length (OR =1.81, 95% CI: 1.331-2.461, P<0.001), and Tumor stage (OR =1.459, 95% CI: 1.235-1.724, P<0.001). Conclusions Our results demonstrate that elevated PLR was significantly associated with poor prognosis of esophageal cancer. Furthermore, the high PLR might predict worse clinicopathological features of esophageal cancer patients.
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Affiliation(s)
- Juhong Deng
- Department of Endocrinology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Peng Zhang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yue Sun
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ping Peng
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yu Huang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Liu FT, Gao H, Wu CW, Zhu ZM. The association of plasma fibrinogen with clinicopathological features and prognosis in esophageal cancer patients. Oncotarget 2017; 8:93029-93038. [PMID: 29190975 PMCID: PMC5696241 DOI: 10.18632/oncotarget.21746] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 08/04/2017] [Indexed: 01/17/2023] Open
Abstract
Background Numerous studies have shown that plasma fibrinogen was linked to esophageal cancer (EC) risk. However, the clinical significance of plasma fibrinogen in EC patients remain unclear and need to be further clarified. Results A total of 2865 patients with EC from 11 published studies were included in this meta-analysis. The prognostic and clinical relevance of plasma fibrinogen were evaluated in EC patients. Statistical significance of the pooled hazard ratio (HR) was found for overall survival (OS), disease free survival (DFS) and recurrence-free survival (RFS) in EC. Subgroup analyses for OS were also performed to confirm the prognostic value of plasma fibrinogen. Additionally, the overall results indicated that elevated plasma fibrinogen was significantly associated with tumor invasion, lymph node metastasis (LNM) and clinical stage. Materials and Methods A comprehensive literature retrieval was performed in PubMed, Embase, Cochrane database, Web of science and Chinese National Knowledge Infrastructure (CNKI) and Wanfang databases to identify relevant studies published prior to April 15, 2017. Conclusions Elevated plasma fibrinogen could be served as a promising biomarker for predicting a poor prognosis and unfavorable clinicopathologic features for EC.
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Affiliation(s)
- Fang-Teng Liu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, P.R. China
| | - Hui Gao
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, P.R. China
| | - Chang-Wen Wu
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, P.R. China
| | - Zheng-Ming Zhu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, P.R. China
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