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Uchida S, Sohda M, Tateno K, Watanabe T, Shibasaki Y, Nakazawa N, Kuriyama K, Sano A, Yokobori T, Sakai M, Ogawa H, Shirabe K, Saeki H. Usefulness of the preoperative inflammation-based prognostic score and the ratio of visceral fat area to psoas muscle area on predicting survival for surgically resected adenocarcinoma of the esophagogastric junction. Esophagus 2024; 21:157-164. [PMID: 38112929 DOI: 10.1007/s10388-023-01034-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Sarcopenic obesity is associated with gastrointestinal cancer prognosis through systemic inflammation. However, in patients with adenocarcinoma of the esophagogastric junction (AEG), the relationship between the inflammation-based prognostic score (IBPS), muscle loss, visceral fat mass, and prognosis has not been sufficiently evaluated. We investigated the prognostic value of the preoperative IBPS and the visceral fat area ratio to the psoas muscle area (V/P ratio) in patients with AEG undergoing surgery. METHODS We retrospectively analyzed 92 patients with AEG who underwent surgery. The prognostic value of the preoperative neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio, systemic inflammation response index, C-reactive protein-to-albumin ratio, prognostic nutritional index, modified Glasgow Prognostic Score, and V/P ratio at the third lumbar vertebra was investigated using univariate and multivariate survival analyses. RESULTS Multivariate analysis revealed that a high pathological stage (p = 0.0065), high PLR (p = 0.0421), and low V/P ratio (p = 0.0053) were independent prognostic factors for poor overall survival (OS). When restricted to patients with body mass index (BMI) ≥ 25 kg/m2, a high V/P ratio was a poor prognostic factor (p = 0.0463) for OS. Conversely, when restricted to patients with BMI < 25 kg/m2, a low V/P ratio was a poor prognostic factor (p = 0.0021) for OS. CONCLUSIONS Both PLR and V/P ratios may be useful prognostic biomarkers in surgical cases of AEG. V/P ratio and BMI may provide an accurate understanding of the muscle and fat mass's precise nature and may help predict AEG prognosis.
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Affiliation(s)
- Shintaro Uchida
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, maebashi-shi, Gunma-ken, 371-8511, Japan
| | - Makoto Sohda
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, maebashi-shi, Gunma-ken, 371-8511, Japan.
| | - Kohei Tateno
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, maebashi-shi, Gunma-ken, 371-8511, Japan
| | - Takayoshi Watanabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, maebashi-shi, Gunma-ken, 371-8511, Japan
| | - Yuta Shibasaki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, maebashi-shi, Gunma-ken, 371-8511, Japan
| | - Nobuhiro Nakazawa
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, maebashi-shi, Gunma-ken, 371-8511, Japan
| | - Kengo Kuriyama
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, maebashi-shi, Gunma-ken, 371-8511, Japan
| | - Akihiko Sano
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, maebashi-shi, Gunma-ken, 371-8511, Japan
| | - Takehiko Yokobori
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, maebashi-shi, Gunma-ken, 371-8511, Japan
| | - Makoto Sakai
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, maebashi-shi, Gunma-ken, 371-8511, Japan
| | - Hiroomi Ogawa
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, maebashi-shi, Gunma-ken, 371-8511, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, maebashi-shi, Gunma-ken, 371-8511, Japan
| | - Hiroshi Saeki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, maebashi-shi, Gunma-ken, 371-8511, Japan
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Fiflis S, Christodoulidis G, Papakonstantinou M, Giakoustidis A, Koukias S, Roussos P, Kouliou MN, Koumarelas KE, Giakoustidis D. Prognostic nutritional index in predicting survival of patients with gastric or gastroesophageal junction adenocarcinoma: A systematic review. World J Gastrointest Oncol 2024; 16:514-526. [PMID: 38425390 PMCID: PMC10900152 DOI: 10.4251/wjgo.v16.i2.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/16/2023] [Accepted: 01/15/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Gastric cancer is the third most common cause of cancer related death worldwide. Surgery with or without chemotherapy is the most common approach with curative intent; however, the prognosis is poor as mortality rates remain high. Several indexes have been proposed in the past few years in order to estimate the survival of patients undergoing gastrectomy. The preoperative nutritional status of gastric cancer patients has recently gained attention as a factor that could affect the postoperative course and various indexes have been developed. The aim of this systematic review was to assess the role of the prognostic nutritional index (PNI) in predicting the survival of patients with gastric or gastroesophageal adenocarcinoma who underwent gastrectomy with curative intent. AIM To investigate the role of PNI in predicting the survival of patients with gastric or gastroesophageal junction adenocarcinoma. METHODS A thorough literature search of PubMed and the Cochrane library was performed for studies comparing the overall survival (OS) of patients with gastric or gastroesophageal cancer after surgical resection depending on the preoperative PNI value. The PRISMA algorithm was used in the screening process and finally 16 studies were included in this systematic review. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO). RESULTS Sixteen studies involving 14551 patients with gastric or esophagogastric junction adenocarcinoma undergoing open or laparoscopic or robotic gastrectomy with or without adjuvant chemotherapy were included in this systematic review. The patients were divided into high- and low-PNI groups according to cut-off values that were set according to previous reports or by using receiver operating characteristic curve analysis in each individual study. The 5-year OS of patients in the low-PNI groups ranged between 39% and 70.6%, while in the high-PNI groups, it ranged between 54.9% and 95.8%. In most of the included studies, patients with high preoperative PNI showed statistically significant better OS than the low PNI groups. In multivariate analyses, low PNI was repeatedly recognised as an independent prognostic factor for poor survival. CONCLUSION According to the present study, low preoperative PNI seems to be an indicator of poor OS of patients undergoing gastrectomy for gastric or gastroesophageal cancer.
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Affiliation(s)
- Stylianos Fiflis
- First Department of Surgery, General Hospital Papageorgiou, Thessaloniki 56429, Greece
| | | | | | | | - Stergos Koukias
- First Department of Surgery, General Hospital Papageorgiou, Thessaloniki 56429, Greece
| | - Paraskevi Roussos
- First Department of Surgery, General Hospital Papageorgiou, Thessaloniki 56429, Greece
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Liu CT, Peng YH, Hong CQ, Huang XY, Chu LY, Lin YW, Guo HP, Wu FC, Xu YW. A Nomogram Based on Nutrition-Related Indicators and Computed Tomography Imaging Features for Predicting Preoperative Lymph Node Metastasis in Curatively Resected Esophagogastric Junction Adenocarcinoma. Ann Surg Oncol 2023; 30:5185-5194. [PMID: 37010663 DOI: 10.1245/s10434-023-13378-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/07/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUNDS Preoperative noninvasive tools to predict pretreatment lymph node metastasis (PLNM) status accurately for esophagogastric junction adenocarcinoma (EJA) are few. Thus, the authors aimed to construct a nomogram for predicting PLNM in curatively resected EJA. METHODS This study enrolled 638 EJA patients who received curative surgery resection and divided them randomly (7:3) into training and validation groups. For nomogram construction, 26 candidate parameters involving 21 preoperative clinical laboratory blood nutrition-related indicators, computed tomography (CT)-reported tumor size, CT-reported PLNM, gender, age, and body mass index were screened. RESULTS In the training group, Lasso regression included nine nutrition-related blood indicators in the PLNM-prediction nomogram. The PLNM prediction nomogram yielded an area under the receiver operating characteristic (ROC) curve of 0.741 (95 % confidence interval [CI], 0.697-0.781), which was better than that of the CT-reported PLNM (0.635; 95% CI 0.588-0.680; p < 0.0001). Application of the nomogram in the validation cohort still gave good discrimination (0.725 [95% CI 0.658-0.785] vs 0.634 [95% CI 0.563-0.700]; p = 0.0042). Good calibration and a net benefit were observed in both groups. CONCLUSIONS This study presented a nomogram incorporating preoperative nutrition-related blood indicators and CT imaging features that might be used as a convenient tool to facilitate the preoperative individualized prediction of PLNM for patients with curatively resected EJA.
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Affiliation(s)
- Can-Tong Liu
- Department of Clinical Laboratory Medicine, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
- Esophageal Cancer Prevention and Control Research Center, The Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
- Guangdong Esophageal Cancer Research Institute, Guangzhou, Guangdong Province, China
| | - Yu-Hui Peng
- Department of Clinical Laboratory Medicine, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
- Esophageal Cancer Prevention and Control Research Center, The Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
- Guangdong Esophageal Cancer Research Institute, Guangzhou, Guangdong Province, China
| | - Chao-Qun Hong
- Department of Oncological Laboratory Research, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Xin-Yi Huang
- Department of Gastrointestinal Endoscopy, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Ling-Yu Chu
- Department of Clinical Laboratory Medicine, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
- Esophageal Cancer Prevention and Control Research Center, The Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
- Guangdong Esophageal Cancer Research Institute, Guangzhou, Guangdong Province, China
| | - Yi-Wei Lin
- Department of Clinical Laboratory Medicine, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
- Esophageal Cancer Prevention and Control Research Center, The Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
- Guangdong Esophageal Cancer Research Institute, Guangzhou, Guangdong Province, China
| | - Hai-Peng Guo
- Esophageal Cancer Prevention and Control Research Center, The Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China.
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China.
| | - Fang-Cai Wu
- Esophageal Cancer Prevention and Control Research Center, The Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China.
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China.
| | - Yi-Wei Xu
- Department of Clinical Laboratory Medicine, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China.
- Esophageal Cancer Prevention and Control Research Center, The Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China.
- Guangdong Esophageal Cancer Research Institute, Guangzhou, Guangdong Province, China.
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Ge G, Li G, Zhang Z, Zhu Y, Wang W, Ren L, Li Z, Teng M. A Novel Scoring System in Predicting Prognosis After Adjuvant FOLFOX Chemotherapy in Gastric Cancer. Cancer Biother Radiopharm 2023; 38:388-395. [PMID: 35076265 DOI: 10.1089/cbr.2021.0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To evaluate the impact of neutrophil-to-lymphocyte ratio (NLR) and preoperative prognostic nutritional index (PNI) on prognosis of gastric cancer (GC) after adjuvant FOLFOX chemotherapy. Materials and Methods: Data on 749 GC patients who received operation after by adjuvant FOLFOX chemotherapy between January 2013 and December 2015 were enrolled in this study, retrospectively. Receiver-operating characteristic curve analysis was employed to assess optimal cutoff thresholds for PNI and NLR. The GC subjects having a low PNI (<52.8) and high NLR (>1.79) received a score of 2. Any variable that met these standards was scored as 1. If none of the two variables met these standards of the patient was assigned a score of 0. Correlation between PNI-NLR score and GC stage was also evaluated. Results: The mean overall survival (OS) and 5-year OS rate for subjects with PNI-NLR = 2 was lower than those of subjects with PNI-NLR = 1, or 0 (40.9% vs. 52.1%, 76.4% [46.0 vs. 61.0], 68.0 months, p ≤ 0.001). In multivariate analyses, the PNI-NLR score (p ≤ 0.001) and WHO grade (p ≤ 0.001) showed potential to independently influence OS. Conclusions: High PNI-NLR scores can independently affect worse prognosis of GC. Thus, it can be utilized to differentiate low risk from high risk subjects.
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Affiliation(s)
- Guochao Ge
- Department of Liver Transplantation and Hepatic Surgery, Cheeloo College of Medicine, Shandong University, Shandong Qianfoshan Hospital, Jinan, China
- Department of Gastrointestinal Surgery, the Affiliated Wuhu Hospital of East China Normal University (The People's Second Hospital of Wuhu), Wuhu, China
| | - Guangyao Li
- Department of Gastrointestinal Surgery, the Affiliated Wuhu Hospital of East China Normal University (The People's Second Hospital of Wuhu), Wuhu, China
| | - Zhengjun Zhang
- Department of Gastrointestinal Surgery, the Affiliated Wuhu Hospital of East China Normal University (The People's Second Hospital of Wuhu), Wuhu, China
| | - Yong Zhu
- Department of Gastrointestinal Surgery, Cheeloo College of Medicine, Shandong University, Shandong Provincial Hospital, Jinan, China
| | - Wentao Wang
- Department of Liver Transplantation and Hepatic Surgery, Cheeloo College of Medicine, Shandong University, Shandong Qianfoshan Hospital, Jinan, China
| | - Lei Ren
- Department of Liver Transplantation and Hepatic Surgery, Cheeloo College of Medicine, Shandong University, Shandong Qianfoshan Hospital, Jinan, China
| | - Ziqiang Li
- Department of Liver Transplantation and Hepatic Surgery, Cheeloo College of Medicine, Shandong University, Shandong Qianfoshan Hospital, Jinan, China
| | - Mujian Teng
- Department of Liver Transplantation and Hepatic Surgery, Cheeloo College of Medicine, Shandong University, Shandong Qianfoshan Hospital, Jinan, China
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Schiefer S, Wirsik NM, Kalkum E, Seide SE, Nienhüser H, Müller B, Billeter A, Büchler MW, Schmidt T, Probst P. Systematic Review of Prognostic Role of Blood Cell Ratios in Patients with Gastric Cancer Undergoing Surgery. Diagnostics (Basel) 2022; 12:diagnostics12030593. [PMID: 35328146 PMCID: PMC8947199 DOI: 10.3390/diagnostics12030593] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 01/19/2023] Open
Abstract
Various blood cell ratios exist which seem to have an impact on prognosis for resected gastric cancer patients. The aim of this systematic review was to investigate the prognostic role of blood cell ratios in patients with gastric cancer undergoing surgery in a curative attempt. A systematic literature search in MEDLINE (via PubMed), CENTRAL, and Web of Science was performed. Information on survival and cut-off values from all studies investigating any blood cell ratio in resected gastric cancer patients were extracted. Prognostic significance and optimal cut-off values were calculated by meta-analyses and a summary of the receiver operating characteristic. From 2831 articles, 65 studies investigated six different blood cell ratios (prognostic nutritional index (PNI), lymphocyte to monocyte ratio (LMR), systemic immune-inflammation index (SII), monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR)). There was a significant association for the PNI and NLR with overall survival and disease-free survival and for LMR and NLR with 5-year survival. The used cut-off values had high heterogeneity. The available literature is flawed by the use of different cut-off values hampering evidence-based patient treatment and counselling. This article provides optimal cut-off values recommendations for future research.
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Affiliation(s)
- Sabine Schiefer
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (S.S.); (H.N.); (B.M.); (A.B.); (M.W.B.); (P.P.)
| | - Naita Maren Wirsik
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital Cologne, Kerpener Str. 62, 50937 Köln, Germany;
| | - Eva Kalkum
- The Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Im Neuenheimer Feld 130/3, 69120 Heidelberg, Germany;
| | - Svenja Elisabeth Seide
- Institute of Medical Biometry (IMBI), University of Heidelberg, Im Neuenheimer Feld 130/3, 69120 Heidelberg, Germany;
| | - Henrik Nienhüser
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (S.S.); (H.N.); (B.M.); (A.B.); (M.W.B.); (P.P.)
| | - Beat Müller
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (S.S.); (H.N.); (B.M.); (A.B.); (M.W.B.); (P.P.)
| | - Adrian Billeter
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (S.S.); (H.N.); (B.M.); (A.B.); (M.W.B.); (P.P.)
| | - Markus W. Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (S.S.); (H.N.); (B.M.); (A.B.); (M.W.B.); (P.P.)
| | - Thomas Schmidt
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (S.S.); (H.N.); (B.M.); (A.B.); (M.W.B.); (P.P.)
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital Cologne, Kerpener Str. 62, 50937 Köln, Germany;
- Correspondence: ; Tel.: +49-221-478-4804
| | - Pascal Probst
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (S.S.); (H.N.); (B.M.); (A.B.); (M.W.B.); (P.P.)
- The Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Im Neuenheimer Feld 130/3, 69120 Heidelberg, Germany;
- Department of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland
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Kumarasamy C, Tiwary V, Sunil K, Suresh D, Shetty S, Muthukaliannan GK, Baxi S, Jayaraj R. Prognostic Utility of Platelet-Lymphocyte Ratio, Neutrophil-Lymphocyte Ratio and Monocyte-Lymphocyte Ratio in Head and Neck Cancers: A Detailed PRISMA Compliant Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13164166. [PMID: 34439320 PMCID: PMC8393748 DOI: 10.3390/cancers13164166] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 01/19/2023] Open
Abstract
Simple Summary Inflammation plays a major role in cancer development and progression and has the potential to be used as a prognostic marker in cancer. Previous studies have attempted to evaluate PLR, NLR and MLR as indicators of inflammation/prognostic markers in cancer, but there is no common consensus on its application in clinical practice. The aim of this systematic review and meta-analysis (a) assess the prognostic efficacy of all three prognostic markers in comparison to each other and, (b) investigate the prognostic potential of these three markers in HNC. The study followed PRISMA guidelines, with literature being collated from multiple bibliographic databases. Preliminary and secondary screening were carried out using stringent inclusion/exclusion criteria. Abstract Inflammation plays a major role in cancer development and progression and has the potential to be used as a prognostic marker in cancer. Previous studies have attempted to evaluate Platelet-to-lymphocyte ratio (PLR), neutrophil–lymphocyte ratio (NLR) or monocyte–lymphocyte ratio (MLR) as indicators of inflammation/prognostic markers in cancer, but there is no common consensus on their application in clinical practice. The aim of this systematic review and meta-analysis is to (a) assess the prognostic efficacy of all three prognostic markers in comparison to each other and (b) investigate the prognostic potential of these three markers in HNC. The study followed PRISMA guidelines, with the literature being collated from multiple bibliographic databases. Preliminary and secondary screening were carried out using stringent inclusion/exclusion criteria. Meta-analysis was carried out on selected studies using CMA software and HR as the pooled effect size metric. A total of 49 studies were included in the study. The pooled HR values of PLR, NLR and MLR indicated that they were significantly correlated with poorer OS. The pooled effect estimates for PLR, NLR and MLR were 1.461 (95% CI 1.329–1.674), 1.639 (95% CI 1.429–1.880) and 1.002 (95% CI 0.720–1.396), respectively. Significant between-study heterogeneity was observed in the meta-analysis of all three. The results of this study suggest that PLR, NLR and MLR ratios can be powerful prognostic markers in head and neck cancers that can guide treatment. Further evidence from large-scale clinical studies on patient cohorts are required before they can be incorporated as a part of the clinical method. PROSPERO Registration ID: CRD42019121008
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Affiliation(s)
- Chellan Kumarasamy
- School of Health and Medical Sciences, Curtin University, Perth, WA 6102, Australia;
| | - Vaibhav Tiwary
- School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore 632014, India; (V.T.); (G.K.M.)
| | - Krishnan Sunil
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL 32224, USA;
| | - Deepa Suresh
- Division of Endocrinology, Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, FL 32224, USA;
| | - Sameep Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, A Constituent of MAHE, Manipal 576104, India;
| | | | - Siddhartha Baxi
- Radiation Oncology, Genesiscare Gold Coast, John Flynn Hospital, 42 Inland Drive, Tugun, QLD 4224, Australia;
| | - Rama Jayaraj
- Northern Territory Institute of Research and Training, Darwin, NT 0909, Australia
- Correspondence:
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Inoue H, Kosuga T, Kubota T, Konishi H, Shiozaki A, Okamoto K, Fujiwara H, Otsuji E. Significance of a preoperative systemic immune-inflammation index as a predictor of postoperative survival outcomes in gastric cancer. World J Surg Oncol 2021; 19:173. [PMID: 34118953 PMCID: PMC8199826 DOI: 10.1186/s12957-021-02286-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/03/2021] [Indexed: 12/17/2022] Open
Abstract
Background Since inflammation and the immune system contribute to the development and progression of malignancies, parameters that reflect a host’s immune-inflammatory status may be useful prognostic indicators of gastric cancer (GC). The present study examined the clinical significance of a preoperative systemic immune-inflammation index (SII) for predicting postoperative survival outcomes in GC. Methods A total of 447 patients who underwent curative gastrectomy for GC were included in the present study. SII was calculated as platelet count × neutrophil count/lymphocyte count. The prognostic impact of preoperative SII was examined using univariate and multivariate analyses. Results Preoperative SII ranged between 105 and 4455 (median 474), and the optimal cutoff value for predicting overall survival (OS) was 395 based on a receiver operating characteristic curve. The 5-year OS rate of the SII ≥ 395 group was 80.0%, which was significantly worse than that (92.7%) of the SII < 395 group (p < 0.001). The multivariate analysis identified SII ≥ 395 (hazard ratio [HR] 2.95; 95% confidence interval [CI] 1.49–6.39; p = 0.001), heart disease (HR 2.14, 95% CI 1.07–4.07), C-reactive protein ≥ 0.5 (HR 2.45, 95% CI 1.15–4.94), pT4 (HR 4.46, 95% CI 2.44–8.14), and pN+ (HR 4.02, 95% CI 2.10–7.93) as independent predictors of worse OS. Peritoneal recurrence was more frequent in the high SII group than in the low SII group (p = 0.028). Conclusion Preoperative SII may be a useful predictor of postoperative survival outcomes in GC. The meticulous surveillance of GC relapse, particularly peritoneal dissemination, is necessary for patients with SII ≥ 395 even after curative gastrectomy. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02286-3.
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Affiliation(s)
- Hiroyuki Inoue
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Toshiyuki Kosuga
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan. .,Department of Surgery, Saiseikai Shiga Hospital, Ritto, Shiga, Japan.
| | - Takeshi Kubota
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hirotaka Konishi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Atsushi Shiozaki
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuma Okamoto
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hitoshi Fujiwara
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
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Hirahara N, Matsubara T, Kaji S, Kawabata Y, Hyakudomi R, Yamamoto T, Uchida Y, Ishitobi K, Takai K, Tajima Y. Glasgow prognostic score is a better predictor of the long-term survival in patients with gastric cancer, compared to the modified Glasgow prognostic score or high-sensitivity modified Glasgow prognostic score. Oncotarget 2020; 11:4169-4177. [PMID: 33227100 PMCID: PMC7665228 DOI: 10.18632/oncotarget.27796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/17/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Inflammation influences cancer progression by increasing catabolism and impairing nutrient absorption. We compared the prognostic ability of three inflammation-based prognostic scoring systems—the Glasgow prognostic score (GPS), modified GPS (mGPS), and high-sensitivity mGPS (HS-mGPS)—in gastric cancer patients. Materials and Methods: We retrospectively examined 434 curatively resected gastric cancer patients to evaluate the prognostic ability of scoring systems for overall survival (OS) and cancer-specific survival (CSS). Results: OS analysis identified the following independent prognostic factors: GPS model: pathological stage (pStage, p < 0.001), carcinoembryonic antigen (CEA, p = 0.004), and GPS 1 (hazard ratio [HR], 1.929; 95% confidence interval [CI], 1.152-3.228; p = 0.013); mGPS model: body mass index (BMI, p = 0.027), pStage (p < 0.001), and CEA (p < 0.001); HS-mGPS model: BMI (p = 0.029), pStage (p < 0.001), and CEA (p = 0.003). mGPS and HS-mGPS were not independent prognostic factors for OS. CSS analysis of the GPS model identified pStage (p < 0.001), CEA (p = 0.015), and GPS 1 (HR; 2.095, 95% CI; 1.025–4.283; p = 0.043) and 2 (HR, 2.812; 95% CI, 1.111–7.116; p = 0.029) as independent prognostic factors; however, mGPS and HS-mGPS were not independent prognostic factors for CSS. Log-rank tests demonstrated significant differences in OS among patients with GPS 0 vs. 1 (p < 0.001) and 0 vs. 2 (p < 0.001) and in CSS among the three GPS (0 vs. 1; p = 0.005, 0 vs. 2; p < 0.001, 1 vs. 2; p = 0.009). Conclusions: GPS most reliably predicts long-term survival of gastric cancer patients.
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Affiliation(s)
- Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Shimane, Japan
| | - Takeshi Matsubara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Shimane, Japan
| | - Shunsuke Kaji
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Shimane, Japan
| | - Yasunari Kawabata
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Shimane, Japan
| | - Ryoji Hyakudomi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Shimane, Japan
| | - Tetsu Yamamoto
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Shimane, Japan
| | - Yuki Uchida
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Shimane, Japan
| | - Kazunari Ishitobi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Shimane, Japan
| | - Kiyoe Takai
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Shimane, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Shimane, Japan
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9
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Tang X, Cao Y, Liu J, Wang S, Yang Y, Du P. Diagnostic Value of Inflammatory Factors in Pathology of Bladder Cancer Patients. Front Mol Biosci 2020; 7:575483. [PMID: 33251247 PMCID: PMC7674661 DOI: 10.3389/fmolb.2020.575483] [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: 06/30/2020] [Accepted: 10/08/2020] [Indexed: 11/13/2022] Open
Abstract
We conducted this study to evaluate the diagnostic value of Inflammatory Factors (IFs) in the pathology of bladder cancer patients. The patients who were diagnosed with urothelial bladder carcinoma (bladder cancer) and underwent surgical treatment in our center from 2014 to 2019 were enrolled. The values of Neutrophil to Lymphocyte Ratio (NLR), derived Neutrophil to Lymphocyte Ratio (dNLR), Platelet to Lymphocyte Ratio (PLR), Lymphocyte to Monocyte Ratio (LMR), Systemic Immune-inflammation Index (SII), and Prognostic Nutritional Index (PNI) were calculated by blood routine test results before operation. After obtaining the postoperative pathology of the patients, the Area Under Curve (AUC) of Receiver Operating Characteristic (ROC) curves was calculated to evaluate the diagnostic value of these IFs in pathology and their corresponding cut-off values. A total of 641 bladder cancer patients were enrolled. The median values of NLR, dNLR, PLR, LMR, SII, and PNI were 6.33, 4.09, 156.47, 2.66, 1114.29, and 51.45, respectively. Grouped patients according to the pathological grade, the NLR, dNLR, PLR, and SII of the high-grade group were significantly higher than those of the low-grade group (P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively), while the LMR and PNI were significantly lower than those of the low-grade group (P = 0.003 and P < 0.001). Divided patients into non-muscle invasion group (Tis + Ta + T1) and muscle invasion group (T2 + T3 + T4), in which NLR, dNLR, PLR, and SII in the muscle invasion group were significantly higher than those in the non-muscle invasion group (P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively), while LMR and PNI were significantly lower than those in the low-grade group (P = 0.012 and P < 0.001). ROC curves analyses showed that NLR, dNLR, PLR, LMR, SII, and PNI had predictive value for pathological grade (P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively) and muscle invasion (P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively). The results suggest the higher NLR, dNLR, PLR, SII, and lower LMR and PNI are associated with higher risk of high-grade and muscle invasive disease. However, this conclusion needs to be further clarified in the future.
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Affiliation(s)
- Xingxing Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Urology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yudong Cao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Urology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jia Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Urology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shuo Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Urology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yong Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Urology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Peng Du
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Urology, Peking University Cancer Hospital & Institute, Beijing, China
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10
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Ge K, Fang C, Zhu D, Yan H, Wang Q, Chen W, Wu J. The Prognostic Value of the Prognostic Nutritional Index (PNI) in Radically Resected Esophagogastric Junction Adenocarcinoma. Nutr Cancer 2020; 73:2589-2596. [PMID: 33135475 DOI: 10.1080/01635581.2020.1841252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To determine the influence of preoperative prognostic nutritional index in adenocarcinoma of the esophagogastric junction, this study was conducted to analyze 420 patients with adenocarcinoma of the esophagogastric junction who underwent surgery. A total of 120 healthy volunteers were included as the healthy control group. The cutoff values of prognostic nutritional index for predicting survival were obtained according to the receiver operating characteristic curve. The clinic-pathological feature and survival were compared between low and high prognostic nutritional index group. Results showed that the prognostic nutritional index in the patient group was lower than that in the healthy control group (P < 0.05). The level of prognostic nutritional index was significantly associated with tumor differentiation, Siewert type, tumor size, body mass index, and hemoglobin levels (P < 0.05). The level of prognostic nutritional index was negatively correlated with age of onset, tumor differentiation, Siewert type, tumor size, depth of tumor, but positively associated with the levels of body mass index and hemoglobin. Multivariate analysis revealed that prognostic nutritional index was an independent factor associated with disease-free survival (P = 0.027) and overall survival (P = 0.003). In conclusion, low prognostic nutritional index may be considered as an independent adverse prognostic marker in patients with adenocarcinoma of the esophagogastric junction.
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Affiliation(s)
- Kele Ge
- Departments of Oncology, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Cheng Fang
- Departments of Oncology, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Danxia Zhu
- Departments of Oncology, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Haijiao Yan
- Departments of Oncology, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Qi Wang
- Departments of Oncology, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Wenyu Chen
- Departments of Oncology, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jun Wu
- Departments of Oncology, the Third Affiliated Hospital of Soochow University, Changzhou, China
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11
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Sugawara K, Yamashita H, Urabe M, Okumura Y, Yagi K, Aikou S, Seto Y. Geriatric Nutrition Index Influences Survival Outcomes in Gastric Carcinoma Patients Undergoing Radical Surgery. JPEN J Parenter Enteral Nutr 2020; 45:1042-1051. [PMID: 32740962 DOI: 10.1002/jpen.1978] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The survival impact of the geriatric nutrition risk index (GNRI) has yet to be investigated in patients undergoing gastric carcinoma (GC) surgery. METHODS In total, 1166 GC patients who underwent radical gastrectomy were retrospectively reviewed. The predictive and discrimination abilities for overall survival (OS) were compared among GNRI, nutrition indices, and systemic inflammatory markers. Patients were dichotomized by GNRI (GNRI <98, low; GNRI ≥98, high), and the impacts of GNRI on OS and cancer-specific survival (CSS) were evaluated using Cox hazards analysis. RESULTS GNRI showed superior discrimination and predictive ability for OS as compared with other indices. There were 447 (38.3%) and 719 (61.7%) patients in the low- and high-GNRI groups, respectively. Patients with low GNRI were older and had a higher pStage III disease rate than those with high GNRI (P < .001). OS curves were significantly stratified by GNRI in all patients (P < .001) and those with pStage I (P < .001), II (P < .001), and III (P = .02) disease. Multivariate analysis showed low GNRI to be independently associated with poor OS (hazard ratio [HR], 2.15; 95% CI, 1.612.87; P < .001). Furthermore, low GNRI was an independent predictor of poor CSS (HR, 1.61; 95% CI, 1.072.44; P = .02), as were total gastrectomy (P < .001) and pStage III disease (P < .001). Patients who had low GNRI and underwent total gastrectomy showed quite poor 5-year OS (54.8%). CONCLUSION GNRI is useful for predicting survival and oncological outcomes in GC patients.
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Affiliation(s)
- Kotaro Sugawara
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Masayuki Urabe
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.,Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Yasuhiro Okumura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Susumu Aikou
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.,Department of Bariatric and Metabolic Care, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
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12
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Clinicopathological and prognostic significance of platelet-lymphocyte ratio (PLR) in gastric cancer: an updated meta-analysis. World J Surg Oncol 2020; 18:191. [PMID: 32731872 PMCID: PMC7391520 DOI: 10.1186/s12957-020-01952-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/07/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Pre-treatment PLR (platelet-lymphocyte ratio) was reported to be associated with the prognosis in gastric cancer (GC), but the results remain inconclusive. This meta-analysis aimed to investigate the prognostic potential of the pre-treatment PLR in gastric cancer. METHODS We performed a systematic literature search in PubMed, Embase, and the Cochrane Library to identify eligible publications. The hazard ratio (HR)/odds ratio (OR) and its 95% confidence (CI) of survival outcomes and clinicopathological parameters were calculated. RESULTS A total of 49 studies (51 cohorts), collecting data from 28,929 GC patients, were included in the final analysis. The pooled results demonstrated that the elevated pre-treatment PLR was significantly associated with poor overall survival (OS) (HR 1.37, 95% CI 1.26-1.49, p < 0.001; I2 = 79.90%, Ph < 0.001) and disease-free survival (DFS) (HR 1.52, 95% CI 1.22-1.90, p < 0.001, I2 = 88.6%, Ph < 0.001). Furthermore, the patients with the elevated PLR had a higher risk of lymph node metastasis (OR = 1.17, 95% CI 1.02-1.33, p = 0.023), serosal invasion (T3+T4) (OR = 1.34, 95% CI 1.10-1.64, p = 0.003), and increased advanced stage (III+IV) (OR = 1.20, 95% CI 1.06-1.37, p = 0.004). CONCLUSIONS An elevated pre-treatment PLR was a prognostic factor for poor OS and DFS and associated with poor clinicopathological parameters in GC patients.
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13
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Hao J, Chen C, Wan F, Zhu Y, Jin H, Zhou J, Chen N, Yang J, Pu Q. Prognostic Value of Pre-Treatment Prognostic Nutritional Index in Esophageal Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2020; 10:797. [PMID: 32626652 PMCID: PMC7311778 DOI: 10.3389/fonc.2020.00797] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/22/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Prognostic nutritional index (PNI), combining albumin and lymphocyte counts, which represent the nutritional and immune status, was considered as an effective predictor for the patient's prognosis after surgery. To comprehensively analyze the relative effectiveness of prognostic performance of pretreatment PNI in esophageal cancer (EC), we performed this meta-analysis. Methods: We performed a systematic search in PubMed, Embase, CNKI, and Web of Science. The hazard ratios (HRs) or odds ratios (ORs) with their corresponding 95% confidence intervals (CIs) were extracted to explore the correlation between PNI and the post-operative survival of patients with EC, including overall survival (OS), recurrence-free survival (RFS), and post-operative complications. The Newcastle-Ottawa Scale (NOS) was applied to estimate the quality of the included studies. The Begg's test was applied to assess the publication bias. Results: A total of 13 articles with 3,543 patients, were included in our meta-analysis, and nine studies reported OS in 2,731 EC patients. The pooled results of the nine studies suggested that EC patients with a low PNI would have a worse overall survival (HR = 1.14, 95% CI 0.99-1.31, p < 0.05). The integrated results also indicated that the PNI was a negative predictor for RFS. Conclusion: This meta-analysis indicated a high correlation between PNI and post-operative survival of EC. EC patients with low PNI values tend to have worse OS and may be at a higher risk of EC recurrence. However, more relevant researches are needed to confirm the association between PNI and post-operative complications of EC.
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Affiliation(s)
- Jianqi Hao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Cong Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Fangfang Wan
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yuzhou Zhu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Hongyu Jin
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Nan Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jing Yang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
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14
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van Hootegem SJM, Smithers BM, Gotley DC, Brosda S, Thomson IG, Thomas JM, Gartside M, Barbour AP. Baseline neutrophil-lymphocyte ratio holds no prognostic value for esophageal and junctional adenocarcinoma in patients treated with neoadjuvant chemotherapy. Dis Esophagus 2020; 33:5610875. [PMID: 31676907 DOI: 10.1093/dote/doz082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/24/2019] [Accepted: 08/08/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several studies have reported that neutrophil-lymphocyte ratio (NLR) can predict survival in esophageal and gastroesophageal junction adenocarcinoma, as it reflects systemic inflammation. Hence, we aimed to determine whether baseline NLR holds prognostic value for esophageal adenocarcinoma patients treated with neoadjuvant chemotherapy (nCT) followed by surgery. METHODS We studied the data of 139 patients that received nCT before undergoing esophagectomy with curative intent, all identified from a prospectively maintained database (1998-2016). Pretreatment hematology reports were used to calculate the baseline NLR. A receiver operating characteristic curve (ROC-curve) was plotted to determine an optimal cutoff value. NLR quartiles were used to display possible differences between groups in relation to overall survival (OS) and disease-free survival (DFS) using the method of Kaplan-Meier. Cox regression analysis was performed to assess the prognostic value of NLR. RESULTS The median OS and DFS times were 46 months (interquartile range [IQR]: 19-166) and 30 months (IQR: 13-166], respectively, for the entire cohort. The ROC-curve showed that NLR has no discriminating power for survival status (area under the curve = 0.462) and therefore no optimal cutoff value could be determined. There were no statistically significant differences in median OS times for NLR quartiles: 65 (Q1), 32 (Q2), 45 (Q3), and 46 months (Q4) (P = 0.926). Similarly, DFS showed no difference between quartile groups, with median survival times of 27 (Q1), 19 (Q2), 36 (Q3), and 20 months (Q4) (P = 0.973). Age, pN, pM, and resection margin were independent prognostic factors for both OS and DFS. On the contrary, NLR was not associated with OS or DFS in univariable and multivariable analyses. CONCLUSION Baseline NLR holds no prognostic value for esophageal and gastroesophageal junction adenocarcinoma patients treated with nCT in this study, in contrast to other recently published papers. This result questions the validity of NLR as a reliable prognostic indicator and its clinical usefulness in these patients.
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Affiliation(s)
- S J M van Hootegem
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.,The University of Queensland, Diamantina Institute, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - B M Smithers
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Queensland, Australia.,Mater Research Institute, Mater Health Services, South Brisbane, Australia
| | - D C Gotley
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - S Brosda
- The University of Queensland, Diamantina Institute, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - I G Thomson
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - J M Thomas
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Australia.,Mater Research Institute, Mater Health Services, South Brisbane, Australia
| | - M Gartside
- The University of Queensland, Diamantina Institute, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - A P Barbour
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Queensland, Australia.,The University of Queensland, Diamantina Institute, Translational Research Institute, Woolloongabba, Queensland, Australia
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15
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Dynamic evaluation of neutrophil-to-lymphocyte ratio as prognostic factor in stage III non-small cell lung cancer treated with chemoradiotherapy. Clin Transl Oncol 2020; 22:2333-2340. [PMID: 32449125 DOI: 10.1007/s12094-020-02396-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/12/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Locally advanced non-small cell lung cancer (LA-NSCLC) is frequently treated with chemoradiotherapy (CRT). Despite the efforts, long-term outcomes are poor, and novel therapies have been introduced to improve results. Biomarkers are needed to detect early treatment failure and plan future follow-up and therapies. Our aim is to evaluate the role of dynamics of neutrophil-to-lymphocyte ratio (NLR) in patients with locally advanced NSCLC treated with CRT. METHODS We retrospectively reviewed patients diagnosed with LA-NSCLC receiving definitive CRT at our center from 2010 to 2015. Baseline and post-treatment NLR were collected from our center database. NLR was dichotomized (threshold = 4) and patients were divided into two groups based on the variation from baseline to post-treatment NLR. The prognostic role and association with response were examined with logistic regression and multivariate Cox regression model, respectively. RESULTS Ninety-two patients were included. Our analysis shows that NLR after treatment is associated with response to treatment [OR in the multivariate analysis 4.94 (1.01-24.48); p value = 0.048]. Furthermore, NLR and ECOG are independent prognostic factors for progression-free survival (PFS) and overall survival (OS). Specifically, PFS was 25.79 months for the good prognosis group and 12.09 for the poor prognosis group [HR 2.98 (CI 95% = 1.74-5.10), p < 0.001]; and OS was 42.94 months and 18.86 months, respectively [HR 2.81 (CI 95% = 1.62-4.90), p < 0.001]. CONCLUSION Dynamics of NLR have a prognostic value in stage III NSCLC treated with definitive CRT. Pre- and post-CRT NLR should be evaluated in prospective clinical trials involving consolidation treatment with immunotherapy.
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Sugawara K, Yamashita H, Urabe M, Okumura Y, Yagi K, Aikou S, Seto Y. Poor nutritional status and sarcopenia influences survival outcomes in gastric carcinoma patients undergoing radical surgery. Eur J Surg Oncol 2020; 46:1963-1970. [PMID: 32402508 DOI: 10.1016/j.ejso.2020.04.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/18/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The survival impacts of the prognostic nutritional index (PNI) and sarcopenia have been separately investigated in patients with gastric carcinoma (GC), while the prognostic impact of the combination of them remains to be addressed. METHODS In total, 1166 GC patients undergoing radical gastrectomy were retrospectively reviewed. A new prognostic score (PNIS) was developed based on preoperative PNI and sarcopenia; patients with both low PNI (≤44.8) and sarcopenia were allocated a score of 2, and those with only one or neither of these abnormalities were assigned a score of 1 or 0, respectively. RESULTS A lower PNI was independently associated with sarcopenia (P = 0.007). There were 704 (60.4%), 356 (30.5%) and 106 (9.1%) patients in the PNIS 0, 1 and 2 groups, respectively. A higher PNIS was associated with advanced age (P < 0.001) and a higher incidence of postoperative complications (P = 0.01). Patients with PNIS 2 showed significantly poorer overall survival (OS) than those with PNIS 1 or 0 (5-year OS; 57.8% vs. 79.2% vs. 91.6%, P < 0.001). Multivariate Cox hazards analysis showed PNIS 2 to be a powerful predictor of poor OS (HR 5.73, P < 0.001) in patients with pStage I disease, while not being independently associated with OS in those with pStage II/III disease. Patients with PNIS 2 had a markedly higher prevalence of non-GC-related death than those with scores of 0-1. CONCLUSION The scoring system combining PNI and sarcopenia is useful for predicting survival outcomes, especially non-GC-related death, in patients with early GC, a population with basically good oncological outcomes.
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Affiliation(s)
- Kotaro Sugawara
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masayuki Urabe
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, 105-8470, Japan
| | - Yasuhiro Okumura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Susumu Aikou
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Bariatric & Metabolic Care, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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17
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Sugawara K, Aikou S, Yajima S, Uemura Y, Okumura Y, Nishida M, Yagi K, Yamashita H, Seto Y. Pre- and post-operative low prognostic nutritional index influences survival in older patients with gastric carcinoma. J Geriatr Oncol 2020; 11:989-996. [PMID: 32146093 DOI: 10.1016/j.jgo.2020.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/21/2019] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The survival impact of the preoperative prognostic nutritional index (PNI) has been investigated in older patients with gastric carcinoma (GC), while that of the postoperative PNI has yet to be addressed. We evaluated the significance of PNI before and after surgery in older GC patients (≥75 years). MATERIALS AND METHODS In total, 309 older GC patients undergoing radical gastrectomy between 2006 and 2016 were retrospectively reviewed. The PNI was evaluated before and at six months after gastrectomy. Patients were divided into low (<45) and high (≥45) PNI groups. The impact of low PNI on overall survival (OS), cancer-specific survival (CSS), and non-GC-related death were investigated. RESULTS Low PNI was present in 134 patients (43.4%) preoperatively and 121 (39.2%) postoperatively. Low pre-PNI was independently associated with poor overall survival (P < .001). Similarly, OS was significantly stratified by post-PNI (P < .001). The significant survival difference according to post-PNI was present only in pStage I disease (P < .001). Low post-PNI independently increased the risk of non-GC-related death in a multivariable analysis (P = .002). In contrast, CSS was not stratified by post-PNI (P = .45). In the high pre-PNI group, total gastrectomy and super-older age (≥80 years) independently increased the risk of low post-PNI, which was significantly associated with poor survival outcomes. CONCLUSIONS Pre- and post-operative PNI are useful for predicting long-term outcomes in older patients with GC. Low postoperative PNI is a powerful determinant of mortality due to other diseases. Optimal perioperative management is required for those at high risk of malnutrition postoperatively.
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Affiliation(s)
- Kotaro Sugawara
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
| | - Susumu Aikou
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan; Department of Bariatric & Metabolic Care, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Sho Yajima
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yukari Uemura
- Biostatistics Division, Clinical Research Support Center, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yasuhiro Okumura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Masato Nishida
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
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Liu XB, Gao ZY, Zhang QH, Pandey S, Gao B, Yang F, Tong Q, Li SB. Preoperative Neutrophil Lymphocyte Ratio Can Be Used as a Predictor of Prognosis in Patients With Adenocarcinoma of the Esophagogastric Junction: A Systematic Review and Meta Analysis. Front Oncol 2020; 10:178. [PMID: 32154173 PMCID: PMC7046751 DOI: 10.3389/fonc.2020.00178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 02/03/2020] [Indexed: 01/19/2023] Open
Abstract
Objective: Neutrophil lymphocyte ratio (NLR), Lymphocyte mononuclear cell ratio (LMR), and Platelet lymphocyte ratio (PLR) can be used as various prognostic factors for malignant tumors, but the value of prognosis for patients with adenocarcinoma of the esophagogastric junction (AEG) has not been determined. This study used meta-analysis to assess the value of these indicators in the evaluation of AEG prognosis. Methods: Relevant literatures on the prognostic relationship between NLR, LMR, PLR, and AEG was retrieved from PubMed, Web of Science, Embase, Cochrane Library, Cochrane Central Register of Controlled Trials, Wanfang data, and Chinese National Knowledge Infrastructure. The search time from database establishment to June 30, 2019. The language is limited to English and Chinese. Data was analyzed using Stata 15.0 software. Result: Six retrospective studies were included, five of them involved NLR and six of them involved PLR. No LMR literature that adequately satisfied the conditions was retrieved. Increased NLR was significantly associated with a significant reduction in overall survival (OS), cancer-specific survival (CSS), or disease specific survival (DSS) in patients with AEG [hazard ratio (HR) = 1.545, 95% CI: 1.096-2.179, P < 0.05]. Subgroup analysis showed that NLR had significant value in the prognosis of both Chinese and Non-Chinese patients (P = 0.009 vs. P = 0.000). NLR had significant prognostic value for ≥3 and <3 groups (P = 0.022 vs. P = 0.000). NLR has a significant prognostic value for samples ≥500 and <500 (P = 0.000 vs. P = 0.022). NLR and OS/CSS/DSS single factor meta-regression showed that regional NLR cut-off values and sample size may be the source of heterogeneity in AEG patients (all P < 0.05). There was no significant association between elevated PLR and OS in patients with AEG (HR = 1.117, 95% CI: 0.960-1.300, P > 0.05). PLR had no significant prognostic value for both Chinese and UK patients (P = 0.282 vs. P = 0.429). PLR had no significant prognostic value for ≥150 group and <150 group (P = 0.141 and P = 0.724). No significant prognostic value was found in either the 300 group and <300 group (P = 0.282 vs. P = 0.429). Conclusion: Preoperative NLR rise was an adverse prognostic indicator of AEG. High-risk patients should be treated promptly. The results showed that PLR was not recommended as a prognostic indicator of AEG.
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Affiliation(s)
- Xiao-Bo Liu
- Department of Gastroenterology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Zi-Ye Gao
- Department of Oncology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Qing-Hui Zhang
- Department of Gastroenterology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Sandeep Pandey
- Department of Gastroenterology, Taihe Hospital, Hubei University of Medicine, Shiyan, China.,Post Graduate Department, Hubei University of Medicine, Shiyan, China
| | - Bo Gao
- Department of Laboratory Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Fan Yang
- Department of Gastroenterology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Qiang Tong
- Department of Gastroenterology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Sheng-Bao Li
- Department of Gastroenterology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
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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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20
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Prognostic Value of the Systemic Inflammation Response Index in Patients with Adenocarcinoma of the Oesophagogastric Junction: A Propensity Score-Matched Analysis. DISEASE MARKERS 2019; 2019:4659048. [PMID: 31781301 PMCID: PMC6875417 DOI: 10.1155/2019/4659048] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/06/2019] [Accepted: 10/10/2019] [Indexed: 01/19/2023]
Abstract
Systemic inflammation is closely related to the occurrence and development of tumours. Based on preoperative neutrophil, monocyte, and lymphocyte counts, a new systemic inflammation response index (SIRI) was established, and the predictive ability of the SIRI for the survival of patients with adenocarcinoma of the oesophagogastric junction (AEG) was evaluated by propensity score matching (PSM) analysis. A total of 302 AEG patients undergoing radical surgery were studied. Univariate and multivariate analyses were performed using Cox proportional hazards regression models. Time-dependent receiver operating characteristic (ROC) curves were used to compare the predictive capabilities of the SIRI. PSM was implemented to balance the baseline characteristics. The results showed that the SIRI, PLR, NLR, and MLR were associated with overall survival (OS) in AEG patients based on the Kaplan-Meier survival analysis. Multivariate analysis demonstrated that the SIRI was an independent prognostic factor. The AUC for the SIRI was significantly greater than that for the NLR, PLR, and MLR in predicting the 3- and 5-year OS of AEG patients. In PSM analysis, the SIRI remained an independent prognostic indicator of OS in AEG patients. The SIRI is a novel, simple, and inexpensive prognostic predictor for AEG. The prognostic value of the SIRI is superior to that of the PLR, NLR, and MLR. The SIRI can be used to distinguish the prognosis of AEG patients with different TNM stages and can be an important supplement to TNM staging.
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21
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Prognostic Significance of CIP2A in Esophagogastric Junction Adenocarcinoma: A Study of 65 Patients and a Meta-Analysis. DISEASE MARKERS 2019; 2019:2312439. [PMID: 31534561 PMCID: PMC6724434 DOI: 10.1155/2019/2312439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/28/2019] [Accepted: 07/16/2019] [Indexed: 12/28/2022]
Abstract
Background The expression of the cancerous inhibitor protein phosphatase 2A (CIP2A) appears to be predictive of the prognosis of various solid tumors. However, the association between this protein and the risk of esophagogastric junction adenocarcinoma (EGJA) remains unclear. We investigated CIP2A expression and its clinical significance in EGJA and conducted a meta-analysis to explore the relationship between CIP2A and the prognosis of patients with solid tumors. Methods Immunohistochemistry (IHC) was performed to detect the expression of CIP2A in EGJA. Kaplan-Meier estimation, Cox analysis, and ROC curves were performed to analyze the survival of patients and the prognostic factors. In the meta-analysis, we searched relevant publications in several widely used databases and used 15 studies (2348 patients). Results IHC demonstrated that CIP2A was elevated in EGJA and correlated with poor survival as an independent indicator. It could forecast the survival more precisely when combined with the grade, which is another independent prognosis marker of EGJA. Meta-analysis demonstrated that the associations between the expression of CIP2A and the prognosis were detected for overall survival (HR = 1.98, 95%CI = 1.69‐2.32), disease-specific survival (HR = 1.72, 95%CI = 1.50‐1.97), and time to tumor progression (pooled HR = 1.95, 95%CI = 1.56‐2.43). Conclusion High expression of CIP2A was a poor indicator of the prognosis of EGJA, and CIP2A may be a new biomarker for the diagnosis and treatment of EGJA. The meta-analysis suggested that CIP2A expression can be a predictive marker of overall survival, disease-specific survival, and time to tumor progression in patients with solid tumors.
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22
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Li J, Xu R, Hu DM, Zhang Y, Gong TP, Wu XL. Prognostic Nutritional Index Predicts Outcomes of Patients after Gastrectomy for Cancer: A Systematic Review and Meta-Analysis of Nonrandomized Studies. Nutr Cancer 2019; 71:557-568. [PMID: 30793968 DOI: 10.1080/01635581.2019.1577986] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The primary aim of this systematic review was to evaluate the survival predication value of preoperative prognostic nutritional index (PNI) in patients with gastric cancer. The second aim was to explore the relationship between preoperative PNI and clinicopathological features. METHODS A systematic search of the electronic databases identified studies that investigated the association of preoperative PNI with short or long-term outcomes among patients after gastrectomy for cancer. Qualitative and quantitative analysis of results was conducted. RESULTS Twenty-five studies with a total of 14,403 patients with gastric cancer met inclusion criteria for this review. Pooled analysis demonstrated that low preoperative PNI was associated with significantly reduced overall survival (HR 1.81, 95% CI: 1.56-2.09; P = 0.000), cancer-specific survival (HR 1.61, 95% CI: 1.24-2.10; P = 0.000), and recurrence-free survival (HR 1.82, 95% CI: 1.20-2.77; P = 0.005). In addition, risk of postoperative complications (POCs) and mortality was significantly higher in patients with lower preoperative PNI (RR 1.77, 95% CI: 1.44-2.17; P = 0.000 and RR 5.14, 95% CI: 2.23-11.79; P = 0.000, respectively). CONCLUSION This study suggests that patients with low preoperative PNI may have a high incidence of POCs and poor prognosis following gastrectomy for cancer.
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Affiliation(s)
- Jian Li
- a Department of General Surgery , The Third Hospital of Mianyang the Mental Health Center of Sichuan , Mianyang , Sichuan , China
| | - Run Xu
- a Department of General Surgery , The Third Hospital of Mianyang the Mental Health Center of Sichuan , Mianyang , Sichuan , China
| | - Deng-Min Hu
- a Department of General Surgery , The Third Hospital of Mianyang the Mental Health Center of Sichuan , Mianyang , Sichuan , China
| | - Yao Zhang
- a Department of General Surgery , The Third Hospital of Mianyang the Mental Health Center of Sichuan , Mianyang , Sichuan , China
| | - Tu-Ping Gong
- a Department of General Surgery , The Third Hospital of Mianyang the Mental Health Center of Sichuan , Mianyang , Sichuan , China
| | - Xue-Lian Wu
- a Department of General Surgery , The Third Hospital of Mianyang the Mental Health Center of Sichuan , Mianyang , Sichuan , China
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23
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Li Z, Xu Z, Huang Y, Wang Y, Karn HR, Zhao R, Cui Y, Zhou Y, Wu X. A systemic review and meta-analysis for prognostic values of pretreatment lymphocyte-to-monocyte ratio on gastric cancer. EUR J INFLAMM 2019. [DOI: 10.1177/2058739219831094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The systemic inflammation plays a crucial role in carcinogenesis and cancer progression. Pretreatment lymphocyte-to-monocyte ratio (LMR) has been suggested to be associated with clinical outcomes in various malignancies. To evaluate the prognostic significance of pretreatment LMR on gastric cancer, we conducted a comprehensive literature search in PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov (Prospero Registration No. CRD42018087263). This meta-analysis included all studies evaluating the prognostic significance of pretreatment LMR on gastric cancer. The main outcome measures included overall survival (OS), progression-free survival (PFS), and the relationship between LMR and clinicopathological features. In total, 11 studies (12 cohorts) enrolling 14,262 patients with gastric cancer were included. The pooled estimates showed that elevated pretreatment LMR was significantly associated with better OS (hazard ratio (HR): 0.71, 95% confidence interval (CI): 0.58–0.83) and better PFS (HR: 0.71, 95% CI: 0.44–0.99). The elevated LMR was also significantly associated with young patients, female, low level of carcinoembryonic antigen (CEA), low level of carbohydrate antigen 19-9 (CA19-9), stage I–II, small tumor size, absence of lymph node metastasis, absence of vascular invasion, and absence of perineural invasion. In conclusion, the elevated pretreatment LMR predicted the better clinical outcomes in patients with gastric cancer.
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Affiliation(s)
- Zhigui Li
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaofen Xu
- Department of Pathology, The Second People’s Hospital of Neijiang City, Neijiang, China
| | - Yuqian Huang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hare Ram Karn
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Zhao
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yaping Cui
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Zhou
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoting Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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Rungsakulkij N, Mingphruedhi S, Suragul W, Tangtawee P, Muangkaew P, Aeesoa S. Platelet-to-Lymphocyte Ratio and Large Tumor Size Predict Microvascular Invasion after Resection for Hepatocellular Carcinoma. Asian Pac J Cancer Prev 2018; 19:3435-3441. [PMID: 30583666 PMCID: PMC6428560 DOI: 10.31557/apjcp.2018.19.12.3435] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Recurrence after curative resection of hepatocellular carcinoma (HCC) is associated with early death and poor prognosis. Microvascular invasion (mVI) is strongly associated with disease recurrence. Although many studies have examined the relationship between various serum inflammatory indices and post-treatment prognosis, little is known about preoperative predictors of microvascular invasion in HCC. Methods: Patients who underwent curative hepatic resection for HCC at our institute from January 2006 to December 2016 were retrospectively reviewed. The associations between mVI and various potential risk factors, including tumor size, hepatitis B and C virus infection, Child–Pugh scores, platelet-to-lymphocyte ratio, and neutrophil-to-lymphocyte ratio, were analyzed. Optimal cut-off values were determined using receiver operating characteristic curves. Results: A total of 330 HCC patients were enrolled in this study, of whom 74 (22.4%) had tumors with mVI. After univariate analysis, two parameters were significantly associated with mVI after hepatic resection: platelet-to-lymphocyte ratio ≥102 (odds ratio [OR] 2.385, p = 0.001) and tumor size ≥5 cm (OR 4.29, p < 0.001). Both variables remained significant risk factors for mVI after multivariate analysis: platelet-to-lymphocyte ratio ≥102 (OR 1.831, p = 0.034) and tumor size ≥5 cm (OR 3.791, p < 0.001). Conclusions: Large tumor size (≥5 cm) and high platelet-to-lymphocyte ratio (≥102) are independent predictive factors for mVI in HCC.
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Affiliation(s)
- Narongsak Rungsakulkij
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Sabra MJ, Crandall M, Smotherman C, Awad ZT. Does serum albumin explain observed racial disparities in mortality for cancer patients undergoing esophagectomy? Am J Surg 2018; 216:778-781. [PMID: 30077314 DOI: 10.1016/j.amjsurg.2018.07.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/11/2018] [Accepted: 07/17/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND African Americans with esophageal cancer have a higher mortality rate than Caucasians. We hypothesized that nutritional status, as reflected by preoperative albumin, might explain these disparities. METHODS The National Surgical Quality Improvement Program database was queried for patients undergoing esophagectomy for esophageal cancer between 2005 and 2015. Preoperative albumin was divided into five categories (<3.0, 3.0-3.4, 3.5-3.9, 4.0-4.4, and >4.4). Univariate and multivariable regression statistics were performed to determine an association between preoperative albumin levels on mortality. RESULTS 3228 patients were studied. While preoperative albumin was associated with lower body mass index, more severe preoperative weight loss, and more respiratory comorbidities (p-values <0.05), albumin levels were not associated with race. On multivariable models including race and other covariates, we found no association of serum albumin and mortality. CONCLUSIONS We found that race was an independent predictor of mortality for patients undergoing esophagectomy. However, preoperative albumin did not explain these disparities.
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Affiliation(s)
- Michel J Sabra
- Department of Surgery, University of Florida College of Medicine Jacksonville, USA
| | - Marie Crandall
- Department of Surgery, University of Florida College of Medicine Jacksonville, USA.
| | - Carmen Smotherman
- Center for Health Equity and Quality Research (CHEQR) at the University of Florida College of Medicine Jacksonville, USA
| | - Ziad T Awad
- Department of Surgery, University of Florida College of Medicine Jacksonville, USA
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Urabe M, Yamashita H, Uemura Y, Tanabe A, Yagi K, Aikou S, Seto Y. Non-linear association between long-term outcome and preoperative neutrophil-to-lymphocyte ratio in patients undergoing curative resection for gastric cancer: a retrospective analysis of 1335 cases in a tetrachotomous manner. Jpn J Clin Oncol 2018; 48:343-349. [PMID: 29420755 DOI: 10.1093/jjco/hyy005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/17/2018] [Indexed: 12/18/2022] Open
Abstract
Objective Although the prognostic utility of the pretreatment neutrophil-to-lymphocyte ratio (NLR) has been widely reported for gastric cancer and several other malignancies, the optimal patient stratification methodologies for such analyses have yet to be established. We aimed to examine the predictive value of preoperative NLR in patients with operable gastric cancer, and to elucidate whether or not the relationship between long-term outcome and pretreatment NLR is monotonically linear. Methods Preoperative data from 1335 patients who underwent curative surgery for gastric cancer were retrospectively evaluated. Patients were divided into four groups (Q1-Q4) according to preoperative NLR (1.59, 2.11 and 2.96). Survival time was calculated applying the Cox proportional hazard model to both univariate and multivariate estimates. Results On univariate Cox regression analysis, preoperative NLR was significantly associated with overall survival (OS) and relapse-free survival (RFS). On subsequent multivariate analysis, preoperative NLR, as a tetrachotomous variable, was independently associated with OS and RFS (P = 0.028, 0.023, respectively). When comparing Q1 with Q3 or Q4 in multivariate analysis, there were no significant prognostic differences in OS (P = 0.23, 0.37, respectively) and RFS (P = 0.26, 0.46, respectively). The Q2 group showed significantly longer RFS than the Q1 group (hazard ratio 0.69, 95% confidence interval 0.48-0.99, P = 0.048). Conclusions Although preoperative NLR was significantly associated with long-term outcome in gastric cancer patients, the association was not linear.
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Affiliation(s)
- Masayuki Urabe
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo
| | - Yukari Uemura
- Biostatistics Division, Clinical Research Support Center, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Asami Tanabe
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo
| | - Susumu Aikou
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo
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Total iron-binding capacity is a novel prognostic marker after curative gastrectomy for gastric cancer. Int J Clin Oncol 2018; 23:671-680. [PMID: 29633053 DOI: 10.1007/s10147-018-1274-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/02/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with gastric cancer (GC) are affected by changes in iron status. Before surgery, GC patients are likely to have iron-deficiency anemia; and after gastrectomy, patients suffer from low nutritional status and low iron. This study investigated preoperative iron status associated with prognosis after curative gastrectomy for gastric cancer. METHODS We evaluated preoperative serum hemoglobin (Hgb), Fe and total iron-binding capacity (TIBC) in 298 patients who underwent curative gastrectomy for GC without preoperative chemotherapy, and analyzed these factors' associations with prognosis after surgery. RESULTS Of the 298 patients, 129 (43.2%) had low Hgb levels, and 33 (11.1%) had low TIBC (< 260 µg/dl) that was not associated with Hgb or Fe level. Patients with low TIBC were significantly associated with older age (≥ 65 years old; P = 0.0085), low albumin (< 3.9 g/dl; P = 0.0388) and high CRP (≥ 0.15 mg/dl; P = 0.0018) in multivariate analysis. Low Fe (< 60 µg/dl) was not associated with disease-free survival (DFS) or overall survival (OS); however, low Fe was associated with longer cancer-specific survival in Stage III GC patients (P = 0.0333). Both low Hgb and low TIBC were significantly associated with shorter DFS (Hgb: P = 0.0433; TIBC: P < 0.0001) and shorter OS (Hgb: P = 0.0352; TIBC: P < 0.0001). Low TIBC were significantly associated with shorter DFS (HR 2.167, 95% CI 1.231-3.639, P = 0.0086) and shorter OS (HR 2.065, 95% CI 1.144-3.570, P = 0.0173) in multivariate Cox hazard regression analysis. CONCLUSIONS Preoperative serum TIBC level of GC patients who undergo curative gastrectomy is a novel prognostic marker in univariate and multivariate analyses.
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