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Matsui R, Ida S, Ri M, Makuuchi R, Hayami M, Kumagai K, Ohashi M, Sano T, Nunobe S. Impact of preoperative prealbumin levels on long-term prognosis in patients with gastric cancer after gastrectomy: a retrospective cohort study. Gastric Cancer 2024; 27:611-621. [PMID: 38402291 DOI: 10.1007/s10120-024-01472-y] [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: 09/16/2023] [Accepted: 01/22/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND The relationship between preoperative prealbumin levels and long-term prognoses in patients with gastric cancer after gastrectomy has not been fully investigated. This study clarified the effect of preoperative prealbumin levels on the long-term prognosis of patients with gastric cancer after gastrectomy. METHODS This retrospective cohort study included consecutive patients who underwent radical gastrectomy for primary pStage I-III gastric cancer and whose preoperative prealbumin levels were measured between May 2006 and March 2017. Participants were categorized according to their preoperative prealbumin levels into high (≥22 mg/dL), moderate (15-22 mg/dL), and low (<15 mg/dL) groups. The overall survival (OS) in the three groups was compared using the log-rank test, and prognostic factors were identified using Cox proportional hazards regression analysis. RESULTS The median follow-up duration was 66 months. Of 4732 patients, 3649 (77.2%) were classified as high, 925 (19.6%) as moderate, and 158 (3.3%) as low. Lower prealbumin levels were associated with poorer prognoses (P < 0.001). Multivariate analysis showed that prealbumin levels of 15-22 mg/dL [hazard ratio (HR): 1.576, 95% confidence interval (CI): 1.353-1.835, P < 0.001] and <15 mg/dL (HR: 1.769, 95% CI: 1.376-2.276, P < 0.001) were independent poor prognostic factors for OS. When analyzed according to the cause of death, prealbumin levels were associated with other-cause survival, but not cancer-specific survival. CONCLUSIONS Preoperative prealbumin levels correlated with OS in patients with gastric cancer after gastrectomy; the lower the prealbumin level, the worse is the prognosis. Prealbumin levels may be associated with other-cause survival.
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Affiliation(s)
- Ryota Matsui
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Satoshi Ida
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Motonari Ri
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Masaru Hayami
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan.
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2
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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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3
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Li J, Zhu N, Wang C, You L, Guo W, Yuan Z, Qi S, Zhao H, Yu J, Huang Y. Preoperative albumin-to-globulin ratio and prognostic nutritional index predict the prognosis of colorectal cancer: a retrospective study. Sci Rep 2023; 13:17272. [PMID: 37828259 PMCID: PMC10570287 DOI: 10.1038/s41598-023-43391-5] [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] [Received: 06/05/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
The immunonutritional status has important effects on outcomes for cancer patients. Albumin-to-globulin ratio (AGR) and the prognostic nutrition index (PNI) are often used to assess the immunonutritional status of cancer patients. However, the clinical significance of these factors in colorectal cancer (CRC) remains unclear. We aimed to evaluate the clinical significance of the AGR and PNI in CRC. We reviewed the clinical data of 511 patients with CRC in two hospitals. Data from one institution was used as the training cohort. The optimal cutoff values for AGR and PNI in the training cohort were 1.4 and 48.65, respectively. Patients in both the low AGR and low PNI groups had poor overall survival (OS) and progression-free survival (PFS), while those in the low AGR-low PNI group had the lowest OS and PFS. Multivariate analysis revealed that preoperative AGR, preoperative PNI, gross type, and TNM stage were independent prognostic factors influencing OS in patients with CRC. Preoperative AGR, preoperative PNI, and TNM stage were independently associated with PFS in patients with CRC. According to the results of multivariate analysis in the training cohort, we developed the nomograms for OS and PFS and performed internal and external validation, which showed good prediction ability of the nomograms. In conclusion, preoperative AGR and PNI can be used as effective indicators to predict survival for patients with CRC. AGR and PNI may help develop effective adjuvant-therapy schedules.
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Affiliation(s)
- JunHu Li
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Na Zhu
- Department of Phase I Clinical Research, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Cheng Wang
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - LiuPing You
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - WenLong Guo
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - ZhiHan Yuan
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shuai Qi
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - HanZheng Zhao
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - JiaYong Yu
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - YueNan Huang
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
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4
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Koga C, Yamashita K, Yukawa Y, Tanaka K, Makino T, Saito T, Yamamoto K, Takahashi T, Kurokawa Y, Nakajima K, Eguchi H, Doki Y. The impact of postoperative blood glucose levels on complications and prognosis after esophagectomy in patients with esophageal cancer. Surg Today 2023:10.1007/s00595-023-02641-9. [PMID: 36658255 DOI: 10.1007/s00595-023-02641-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/29/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE This study aimed to characterize postoperative blood glucose fluctuation in patients who underwent esophagectomy for esophageal cancer, and to define its impact on complications and prognosis. METHODS The subjects of this retrospective study were 284 patients who underwent esophagectomy at Osaka University Hospital between 2015 and 2017. Data analyzed included clinicopathological background, the immediate postoperative blood glucose level (IPBG), postoperative blood glucose variability (PBGV), insulin dosage, postoperative complications, and prognosis. RESULTS The median IPBG and PBGV were 170 (64-260) mg/dl and 64.5 (11-217) mg/dl, respectively. Postoperative pneumonia was more common in patients with PBGV > 100 mg/dl (P = 0.015). Patients with IPBG < 170 mg/dl had significantly worse 5-year overall survival (OS) and 5-year recurrence-free survival (RFS) than those with IPBG > 170 mg/dl (54.5% vs. 80.4%, respectively, [P < 0.001] and 44.3% vs. 69.3%, respectively, [P = 0.001]). The 5-year OS rates were 43.5%, 68.3%, 80.6%, and 79.0% for patients with IPBG < 154, 154-170, 170-190, and ≥ 190 mg/dl, respectively. The corresponding 5-year RFS rates were 38.1%, 52.4%, 77.0%, and 61.3%, respectively. Multivariate analysis revealed that IPBG < 154 mg/dl and pathological stage were independent poor prognostic factors for OS. CONCLUSION PBGV was associated with postoperative pneumonia, and low IPBG was an independent poor prognostic factor for patients with esophageal cancer.
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Affiliation(s)
- Chihiro Koga
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Yoshiro Yukawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita, Osaka, 565-0871, Japan
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5
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AOYAMA TORU, KAZAMA KEISUKE, MAEZAWA YUKIO, HARA KENTARO. Usefulness of Nutrition and Inflammation Assessment Tools in Esophageal Cancer Treatment. In Vivo 2023; 37:22-35. [PMID: 36593006 PMCID: PMC9843752 DOI: 10.21873/invivo.13051] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 01/04/2023]
Abstract
Multidisciplinary treatment for esophageal cancer leads to nutritional and inflammatory changes. Recent studies showed that nutritional and inflammatory changes during multidisciplinary treatment affect both short and long-term oncological outcomes in esophageal cancer treatment. Therefore, evaluation of the nutritional and inflammatory status during treatment is necessary in order to optimize and utilize multidisciplinary therapy for esophageal cancer. If patients with esophageal cancer are able to determine their nutritional and inflammatory status, they will be able to select the optimal esophageal cancer, anti-inflammation, and nutritional treatments. Various types of nutrition and inflammation assessment tools have been developed and reported for esophageal cancer, with each tool having its own clinical characteristics, which must be understood before being applied in clinical practice. This review summarizes the background, current status, and future perspectives on the application of nutrition and inflammation assessment tools in esophageal cancer treatment.
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Affiliation(s)
- TORU AOYAMA
- Department of Surgery, Yokohama City University, Yokohama, Japan,Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - KEISUKE KAZAMA
- Department of Surgery, Yokohama City University, Yokohama, Japan,Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - YUKIO MAEZAWA
- Department of Surgery, Yokohama City University, Yokohama, Japan,Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan,Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - KENTARO HARA
- Department of Surgery, Yokohama City University, Yokohama, Japan,Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan,Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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6
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Wei ZJ, Qiao YT, Zhou BC, Rankine AN, Zhang LX, Su YZ, Xu AM, Han WX, Luo PQ. Model established based on blood markers predicts overall survival in patients after radical resection of types II and III adenocarcinoma of the esophagogastric junction. World J Gastrointest Surg 2022; 14:788-798. [PMID: 36157366 PMCID: PMC9453332 DOI: 10.4240/wjgs.v14.i8.788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/30/2022] [Accepted: 08/05/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In recent years, the incidence of types II and III adenocarcinoma of the esophagogastric junction (AEG) has shown an obvious upward trend worldwide. The prognostic prediction after radical resection of AEG has not been well established.
AIM To establish a prognostic model for AEG (types II and III) based on routine markers.
METHODS A total of 355 patients who underwent curative AEG at The First Affiliated Hospital of Anhui Medical University from January 2014 to June 2015 were retrospectively included in this study. Univariate and multivariate analyses were performed to identify the independent risk factors. A nomogram was constructed based on Cox proportional hazards models. The new score models was analyzed by C index and calibration curves. The receiver operating characteristic (ROC) curve was used to compare the predictive accuracy of the scoring system and tumor-node-metastasis (TNM) stage. Overall survival was calculated using the Kaplan-Meier curve amongst different risk AEG patients.
RESULTS Multivariate analysis showed that TNM stage (hazard ratio [HR] = 2.286, P = 0.008), neutrophil-to-lymphocyte ratio (HR = 2.979, P = 0.001), and body mass index (HR = 0.626, P = 0.026) were independent prognostic factors. The new scoring system had a higher concordance index (0.697), and the calibration curves of the nomogram were reliable. The area under the ROC curve of the new score model (3-year: 0.725, 95% confidence interval [CI]: 0.676-0.777; 5-year: 0.758, 95%CI: 0.708-0.807) was larger than that of TNM staging (3-year: 0.630, 95%CI: 0.585-0.684; 5-year: 0.665, 95%CI: 0.616-0.715).
CONCLUSION Based on the serum markers and other clinical indicators, we have developed a precise model to predict the prognosis of patients with AEG (types II and III). The new prognostic nomogram could effectively enhance the predictive value of the TNM staging system. This scoring system can be advantageous and helpful for surgeons and patients.
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Affiliation(s)
- Zhi-Jian Wei
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Ya-Ting Qiao
- Department of Gastrointestinal Surgery, Affiliated Hospital of HeBei University, Baoding 071000, Hebei Province, China
| | - Bai-Chuan Zhou
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Abigail N Rankine
- Department of Clinical Medicine, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Li-Xiang Zhang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
- Department of Gastroenterology, Anhui Provincial Key Laboratory of Digestive Disease, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Ye-Zhou Su
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - A-Man Xu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Wen-Xiu Han
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Pan-Quan Luo
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
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7
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Yu Y, Wu H, Qiu J, Ke D, Wu Y, Lin M, Liu T, Zheng Q, Zheng H, Yang J, Wang Z, Li H, Liu L, Yao Q, Li J, Cheng W, Chen X. A Nutrition-Related Factor-Based Risk Stratification for Exploring the Clinical Benefits in the Treatment of Patients With Locally Advanced Esophageal Squamous Cell Carcinoma Receiving Definitive Chemoradiotherapy: A Retrospective Cohort Study. Front Nutr 2022; 9:896847. [PMID: 35990358 PMCID: PMC9387592 DOI: 10.3389/fnut.2022.896847] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/22/2022] [Indexed: 01/19/2023] Open
Abstract
Objective No study has reported the risk stratification of BMI and PNI in patients with locally advanced esophageal squamous cell carcinoma (ESCC) undergoing definitive chemoradiotherapy (dCRT). This study aimed to construct a risk stratification to guide the treatment of ESCC following dCRT. Methods A total of 1,068 patients with locally advanced ESCC who received dCRT were retrospectively analyzed. The impacts of clinicopathological factors on overall survival (OS) and progression-free survival (PFS) were analyzed. Besides, the novel prognostic indices of pre-therapeutic nutritional index (PTNI) and prognostic index (PI) were developed. Results The median follow-up period of OS and PFS were 22.9 and 17.4 months, respectively. The high body mass index (BMI) group had better 5-year OS and PFS (36.4 and 34.0%) than the low BMI group (18.8 and 17.2%). The high prognostic nutritional index (PNI) group also had better 5-year OS and PFS (33.4 and 30.9%) than the low PNI group (17.5 and 17.2%). Multivariate Cox regression analysis showed that BMI and PNI were independent prognostic factors for OS and PFS. Based on nutritional indices, patients were categorized into the low-risk (PTNI = 1), medium-risk (PTNI = 2), and high-risk (PTNI = 3) groups with 5-year OS rates of 38.5, 18.9, 17.5%, respectively (p < 0.001) and 5-year PFS rates of 35.8, 17.6, 16.8%, respectively (p < 0.001). Besides, we also constructed a prognostic index (PI) for OS and PFS which was calculated based on statistically significant factors for predicting OS and PFS. The results revealed that the high-risk group had worse OS and PFS than the low-risk group (p < 0.001). Finally, RCS analysis demonstrated a non-linear relationship between the PNI, BMI, and survival for patients with ESCC. The death hazard of PNI and BMI sharply decreased to 41.8 and 19.7. Conclusion The decreased pre-therapeutic BMI and PNI levels were associated with a worse survival outcome. BMI and PNI are readily available and can be used to stratify risk factors for locally advanced ESCC patients undergoing dCRT. The novel risk stratification may help to evaluate patients’ pre-therapeutic status and guide dCRT for locally advanced ESCC patients.
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Affiliation(s)
- Yilin Yu
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China.,College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China.,The Graduate School, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Haishan Wu
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China.,The Graduate School, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Jianjian Qiu
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China.,The Graduate School, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Dongmei Ke
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China.,The Graduate School, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Yahua Wu
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China.,The Graduate School, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Mingqiang Lin
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China.,The Graduate School, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Tianxiu Liu
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China.,The Graduate School, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Qunhao Zheng
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China.,The Graduate School, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Hongying Zheng
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China.,The Graduate School, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Jun Yang
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China.,The Graduate School, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Zhiping Wang
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China.,The Graduate School, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Hui Li
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China.,The Graduate School, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Lingyun Liu
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China.,The Graduate School, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Qiwei Yao
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China.,The Graduate School, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Jiancheng Li
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China.,The Graduate School, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Wenfang Cheng
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China.,The Graduate School, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Xiaohui Chen
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China.,College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China.,The Graduate School, Fujian Medical University, Fuzhou, China
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8
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Boshier PR, Swaray A, Vadhwana B, O’Sullivan A, Low DE, Hanna GB, Peters CJ. Systematic review and validation of clinical models predicting survival after oesophagectomy for adenocarcinoma. Br J Surg 2022; 109:418-425. [PMID: 35233634 PMCID: PMC10364693 DOI: 10.1093/bjs/znac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/10/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Oesophageal adenocarcinoma poses a significant global health burden, yet the staging used to predict survival has limited ability to stratify patients by outcome. This study aimed to identify published clinical models that predict survival in oesophageal adenocarcinoma and to evaluate them using an independent international multicentre dataset. METHODS A systematic literature search (title and abstract) using the Ovid Embase and MEDLINE databases (from 1947 to 11 July 2020) was performed. Inclusion criteria were studies that developed or validated a clinical prognostication model to predict either overall or disease-specific survival in patients with oesophageal adenocarcinoma undergoing surgical treatment with curative intent. Published models were validated using an independent dataset of 2450 patients who underwent oesophagectomy for oesophageal adenocarcinoma with curative intent. RESULTS Seventeen articles were eligible for inclusion in the study. Eleven models were suitable for testing in the independent validation dataset and nine of these were able to stratify patients successfully into groups with significantly different survival outcomes. Area under the receiver operating characteristic curves for individual survival prediction models ranged from 0.658 to 0.705, suggesting poor-to-fair accuracy. CONCLUSION This study highlights the need to concentrate on robust methodologies and improved, independent, validation, to increase the likelihood of clinical adoption of survival predictions models.
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Affiliation(s)
- Piers R Boshier
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alison Swaray
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Bhamini Vadhwana
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Arun O’Sullivan
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Donald E Low
- Department of Thoracic Surgery, Virginia Mason Medical Centre, Seattle, Washington, USA
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
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9
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Du R, Ming J, Geng J, Zhu X, Zhang Y, Li S, Liu Z, Wang H, Wang Z, Tang L, Zhang X, Wu A, Bu Z, Yan Y, Li Z, Li Y, Li Z, Wang W. Establishment of prognostic models for adenocarcinoma of oesophagogastric junction patients with neoadjuvant chemoradiotherapy: a real-world study. Radiat Oncol 2022; 17:45. [PMID: 35241109 PMCID: PMC8896317 DOI: 10.1186/s13014-022-02016-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/17/2022] [Indexed: 01/19/2023] Open
Abstract
Background Multimodal therapies based on surgical resection have been recommended for the treatment of adenocarcinoma of the oesophagogastric junction (AEG). We aimed to evaluate prognostic factors in AEG patients receiving neoadjuvant chemoradiotherapy and to build predictive models. Methods T3 − T4N + M0 AEG patients with resectable Siewert type II/III tumours were enrolled in this study. All patients underwent neoadjuvant chemoradiation, followed by radical surgery or systemic therapy according to clinical response. Survival analysis was performed using the Kaplan–Meier method; multivariate analysis using the Cox proportional hazards method was also conducted. The Harrell concordance index (C-index) was used to test the prognostic value of models involving prognostic factors, and consistency between actual and predicted survival rates was evaluated by calibration curves. Results From February 2009 to February 2018, 79 patients were treated with neoadjuvant chemoradiotherapy; 60 patients of them underwent radical surgery. The R0 resection rate was 98.3%, and 46.7% of patients achieved a major pathologic response (MPR), namely, a residual tumour issue less than 10%. The 5-year overall survival (OS) rate was 63%, and the 5-year progression-free survival (PFS) rate was 48%. The incidence of grade 3 complications was 21.5%, and no grade 4 complications were reported. According to the results of univariate and multivariate analyses, we included the neutrophil–lymphocyte ratio (NLR), prognostic nutrition index (PNI), eosinophilic granulocyte (EOS) and postoperative pathologic stage in nomogram analysis to establish prediction models for OS and PFS; the C-index of each model was 0.814 and 0.722, respectively. Both the C-index and calibration curves generated to validate consistency between the actual and predicted survival indicated that the models were well calibrated and of good predictive value. Conclusions AEG patients achieved favourable downstaging and pathologic response after neoadjuvant chemoradiation, with acceptable adverse effects. Inflammation-based and nutrition-related factors and postoperative pathologic stage had a significant influence on OS and PFS, and the predictive value was verified through prognostic models.
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Affiliation(s)
- Rongxu Du
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Jiao Ming
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Jianhao Geng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Xianggao Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Yangzi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Shuai Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Zhiyan Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Hongzhi Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Zhilong Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Medical Imaging, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Lei Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Medical Imaging, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Xiaotian Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Aiwen Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Zhaode Bu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Yan Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Zhongwu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Yongheng Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China.
| | - Ziyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China.
| | - Weihu Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China.
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10
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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: 51] [Impact Index Per Article: 17.0] [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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11
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Murad LD, Silva TDQ, Schilithz AOC, Monteiro MC, Murad LB, Fialho E. Body Mass Index Alters the Predictive Value of the Neutrophil-to-Lymphocyte Ratio and Systemic Inflammation Response Index in Laryngeal Squamous Cell Carcinoma Patients. Nutr Cancer 2021; 74:1261-1269. [PMID: 34278900 DOI: 10.1080/01635581.2021.1952447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Laryngeal squamous cell carcinoma (LSCC) is a frequent cancer subtype among head and neck cancers. Exacerbated inflammation and nutritional deficit are common features in this type of cancer and can be used as a prognostic marker. This study aimed to investigate the relationship between body mass index (BMI), neutrophil-to-lymphocyte ratio (NLR), and systemic inflammation response index (SIRI) on overall survival (OS) of LSCC patients. In this retrospective cohort study, 168 patients were followed for 5 years. Data on clinical factors, patients' life habits, height, weight, and hematological parameters were collected. BMI, NLR, and SIRI were calculated. Pretreatment NLR≥ 2.02 and SIRI≥ 1160.85 were independent prognostic factors for poor OS. Low BMI did not significantly affect the OS. However, the inflammatory parameters had their predictive capacity altered when stratified by the BMI classification. NLR≥ 2.02 + Low BMI or SIRI≥ 1160.85 + Low BMI increased in 8.6 and 3.8 times the risk of death, respectively. In contrast, stratification by normal/high BMI classification eliminated the predictive capacity of NLR and SIRI. Here, we demonstrated the possible ability of BMI to change the prognostic capacity of inflammatory markers NLR and SIRI in patients with LSCC.Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2021.1952447.
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Affiliation(s)
- Luana Dalbem Murad
- Nutrition and Dietetics Section, Brazilian National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil.,Basic and Experimental Nutrition Department, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thays de Queiroz Silva
- Basic and Experimental Nutrition Department, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Arthur Orlando Corrêa Schilithz
- Nutrition and Dietetics Section, Brazilian National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil
| | - Mariana Costa Monteiro
- Basic and Experimental Nutrition Department, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Borges Murad
- Nutrition and Dietetics Section, Brazilian National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil
| | - Eliane Fialho
- Basic and Experimental Nutrition Department, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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12
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Gao QL, Shi JG, Huang YD. Prognostic Significance of Pretreatment Prognostic Nutritional Index (PNI) in Patients with Nasopharyngeal Carcinoma: A Meta-Analysis. Nutr Cancer 2020; 73:1657-1667. [PMID: 32924631 DOI: 10.1080/01635581.2020.1810715] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Previous studies have investigated the pretreatment prognostic nutritional index (PNI) as a prognostic factor in patients with nasopharyngeal carcinoma (NPC); however, the results remained inconsistent. We aimed to assess the prognostic value of PNI in patients with NPC through conducting meta-analysis. Methods: Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for low PNI of overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), loco-regional recurrence-free survival (LRFS), and cancer-specific survival (CSS). Results: Totally, eight studies involving 4299 patients were included in this meta-analysis. A low pretreatment PNI was associated with poor OS (HR = 1.86, 95% CI = 1.55-2.33, P < 0.001), DMFS (HR = 2.03, 95% CI = 1.69-2.44, P < 0.001), PFS (HR = 1.57, 95% CI = 1.31-1.90, P < 0.001), and CSS (HR = 2.29, 95% CI = 1.54-3.42, P < 0.001). The subgroup analysis showed that low PNI remained a significant factor for poor OS, DMFS, and PFS irrespective of treatment, country, and cutoff value of PNI. In addition, low PNI was correlated to female gender (OR = 1.35, 95% CI = 1.12-1.62, P = 0.002), older age (OR = 1.75, 95% CI = 1.17-2.62, P = 0.007), and T3-T4 stage (OR = 1.27, 95% CI = 1.06-1.53, P = 0.011). Conclusions: A low PNI was associated with poor survival outcomes in patients with NPC. Moreover, PNI could serve as an index to help guide clinical management for older patients.
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Affiliation(s)
- Qiu-Ling Gao
- Department of Radiation Oncology, Weihai Municipal Hospital, Weihai, Shandong, China
| | - Jian-Guo Shi
- Department of Radiation Oncology, Weihai Municipal Hospital, Weihai, Shandong, China
| | - Yu-Dong Huang
- Department of Radiation Oncology, Weihai Municipal Hospital, Weihai, Shandong, China
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13
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Kudou K, Nakashima Y, Haruta Y, Nambara S, Tsuda Y, Kusumoto E, Ando K, Kimura Y, Hashimoto K, Yoshinaga K, Saeki H, Oki E, Sakaguchi Y, Kusumoto T, Ikejiri K, Shimokawa M, Mori M. Comparison of Inflammation-Based Prognostic Scores Associated with the Prognostic Impact of Adenocarcinoma of Esophagogastric Junction and Upper Gastric Cancer. Ann Surg Oncol 2020; 28:2059-2067. [PMID: 32661855 DOI: 10.1245/s10434-020-08821-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/14/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Several inflammation-based prognostic scores have a prognostic value in patients with various cancers. This study investigated the prognostic value of various inflammation-based prognostic scores in patients who underwent a surgery for adenocarcinoma of the esophagogastric junction (AEG) and upper gastric cancer (UGC). METHODS We reviewed data of 206 patients who underwent surgery for AEG and UGC. We calculated neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), Glasgow Prognostic Score (GPS), modified GPS (mGPS), C-reactive protein (CRP)/albumin (Alb) ratio, prognostic index (PI), and prognostic nutritional index (PNI) and analyzed the relationship between these biomarkers and postoperative prognosis. RESULTS In multivariate analyses for overall survival, mGPS (P = 0.0337, hazard ratio [HR] = 5.211), PI (P = 0.0002, HR = 21.20), and PNI (P < 0.0001, HR = 6.907) were identified as independent predictive factors. A multivariate analysis for recurrence-free survival showed that only PI (P = 0.0006, HR = 11.89) and PNI (P = 0.0002, HR = 4.972) were independent predictive factors among the above-mentioned inflammation-based prognostic scores. CONCLUSIONS In various inflammation-based prognostic scores, PI and PNI were more strongly associated with poor prognosis in patients who underwent surgery for AEG and UGC.
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Affiliation(s)
- Kensuke Kudou
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
| | - Yuichiro Nakashima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Haruta
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sho Nambara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yasuo Tsuda
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Eiji Kusumoto
- Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Koji Ando
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasue Kimura
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenkichi Hashimoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Keiji Yoshinaga
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hiroshi Saeki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihisa Sakaguchi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Tetsuya Kusumoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Koji Ikejiri
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Mototsugu Shimokawa
- Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masaki Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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14
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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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15
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Zu H, Wang H, Li C, Xue Y. Preoperative prealbumin levels on admission as an independent predictive factor in patients with gastric cancer. Medicine (Baltimore) 2020; 99:e19196. [PMID: 32176046 PMCID: PMC7440214 DOI: 10.1097/md.0000000000019196] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/28/2019] [Accepted: 01/15/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND To explore the role of preoperative prealbumin levels in predicting the prognosis of patients with gastric cancer. METHODS A total of 989 gastric cancer patients in the Affiliated Tumour Hospital of Harbin Medical University who underwent gastrectomy were included in this retrospective study. The preoperative prealbumin level, clinicopathological data, and follow-up data were recorded. According to the maximum chi-square survival correlation value, the survival of patients with low preoperative prealbumin (<140 mg/L) and high preoperative prealbumin (≥140 mg/L) were compared using the log-rank test and the Cox proportional hazard regression model. RESULTS Based on the best cut-off value of 140 mg/L, we divided the patients into the lower prealbumin group (<140 mg/L) and the higher prealbumin group (≥140 mg/L). Compared with the higher prealbumin group, the lower prealbumin group were older and had larger tumor volumes, lower hemoglobin (Hb) levels, and more upper gastric cancer tumors. The univariate analysis showed that prealbumin and other clinicopathological factors, including age, hemoglobin, tumor size, macroscopic type, cell differentiation, liver metastasis, operation type, N stage, and T stage, were significant prognostic factors. The multivariable analysis showed that age, prealbumin, macroscopic type, location, T stage, and N stage were independent prognostic factors. CONCLUSIONS The preoperative prealbumin level was an independent prognostic factor for patients with gastric cancer. The preoperative prealbumin level can be used to predict the prognosis of patients with gastric cancer and guide clinical practice.
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Affiliation(s)
| | - Huiling Wang
- Department of ICU, The First People's Hospital of Zhaoqing, Zhaoqing City, Guangdong Province
| | - Chunfeng Li
- Department of Gastroenterologic Surgery, Affiliated Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yingwei Xue
- Department of Gastroenterologic Surgery, Affiliated Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
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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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17
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Liao G, Zhao Z, Yang H, Chen M, Li X. Can Prognostic Nutritional Index be a Prediction Factor in Esophageal Cancer?: A Meta-Analysis. Nutr Cancer 2020; 72:187-193. [PMID: 31272238 DOI: 10.1080/01635581.2019.1631859] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective: Prognostic nutritional index (PNI) can be used for survival predication in patients with esophageal cancer (EC). However, the prognostic value of PNI in EC is inconclusive in accordance to the literature. This meta-analysis aimed to evaluate the prediction value of PNI in EC.Methods: Studies focus on the association of PNI and EC were retrieved from the electronic databases. Standard meta-analysis methods were used for data evaluation.Results: Our search yield 12 studies, involving 3118 patients with EC for data analysis. The pooled data suggested that low PNI was correlated with worse overall survival (hazard ratio (HR) = 1.29, 95% confidence interval (CI):1.11-1.50, P = 0.001) and cancer-specific survival (HR = 2.18, 95% CI: 1.68-2.83, P < 0.0001). Moreover, lower PNI was associated with unfavorable prognostic factors (the presence of lymph node metastasis, deeper tumor invasion and advanced TNM stages).Conclusion: The lower PNI was correlated with unfavorable prognostic factor and poor prognosis in patients with EC.
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Affiliation(s)
- Guixiang Liao
- Department of Oncology, Shenzhen People's Hospital, Second Clinical Medicine Centre, Jinan University, Guangdong, China
| | - Zhihong Zhao
- Department of Nephrology, Shenzhen People's Hospital, Second Clinical Medicine Centre, Jinan University, Guangdong, China
| | - Hongli Yang
- Department of Oncology, Shenzhen People's Hospital, Second Clinical Medicine Centre, Jinan University, Guangdong, China
| | - Meili Chen
- Department of Oncology, Shenzhen People's Hospital, Second Clinical Medicine Centre, Jinan University, Guangdong, China
| | - Xianming Li
- Department of Oncology, Shenzhen People's Hospital, Second Clinical Medicine Centre, Jinan University, Guangdong, China
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18
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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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19
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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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20
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Zhang Y, Zhu JY, Zhou LN, Tang M, Chen MB, Tao M. Predicting the Prognosis of Gastric Cancer by Albumin/Globulin Ratio and the Prognostic Nutritional Index. Nutr Cancer 2019; 72:635-644. [PMID: 31423840 DOI: 10.1080/01635581.2019.1651347] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Yan Zhang
- Department of Oncology, the first Affiliated Hospital of Soochow University, Jiangsu, China
- Department of Oncology, Affiliated Kunshan Hospital of Jiangsu University, Jiangsu, China
| | - Jia-Yao Zhu
- Department of Oncology, Affiliated Kunshan Hospital of Jiangsu University, Jiangsu, China
| | - Li-Na Zhou
- Department of Oncology, Affiliated Kunshan Hospital of Jiangsu University, Jiangsu, China
| | - Min Tang
- Department of Oncology, Affiliated Kunshan Hospital of Jiangsu University, Jiangsu, China
| | - Min-Bin Chen
- Department of Oncology, Affiliated Kunshan Hospital of Jiangsu University, Jiangsu, China
| | - Min Tao
- Department of Oncology, the first Affiliated Hospital of Soochow University, Jiangsu, China
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21
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Prognostic Value of Pretreatment Serum Transthyretin Level in Patients with Gastrointestinal Cancers. DISEASE MARKERS 2019; 2019:7142065. [PMID: 31275452 PMCID: PMC6589268 DOI: 10.1155/2019/7142065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/18/2019] [Indexed: 01/19/2023]
Abstract
Background Many studies have shown the link between the pretreatment serum transthyretin and prognosis in gastrointestinal (GI) cancers. However, based on the conclusion, the initial findings were inconsistent. Hence, this meta-analysis was performed to identify the prognostic values of the pretreatment serum transthyretin in GI cancers. Methods Previous studies published before November 2018 were collected from a comprehensive literature search of several databases. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were applied in the assessment of the intensity of associations. Also, the publication bias and the robustness of merged data were assessed. All statistical analyses were undertaken using STATA/SE 14.1. Results The combined data indicated that the pretreatment serum transthyretin level was related to the prognosis in GI cancers. The group with reduced pretreatment transthyretin had a significantly worse overall survival (OS) (HR = 1.71, 95% CI: 1.37-2.05). The subgroup analysis for OS further showed the predictive value of transthyretin. In addition, the low serum transthyretin level could be an unfavorable factor for recurrence-free survival (RFS) or progression-free survival (PFS) (HR = 1.66, 95% CI: 1.14-2.18) in GI cancers. Conclusion The low pretreatment serum transthyretin level implies an unfavorable prognosis for patients with GI cancers. The monitoring of pretreatment transthyretin level could contribute to the risk stratification and individualized therapy in GI cancers.
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22
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Li P, Wang X, Lai Y, Zhou K, Tang Y, Che G. The prognostic value of pre-treatment prognostic nutritional index in esophageal squamous cell carcinoma: A meta-analysis. Medicine (Baltimore) 2019; 98:e15280. [PMID: 31145271 PMCID: PMC6709023 DOI: 10.1097/md.0000000000015280] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Prognostic nutritional index (PNI) is an easily obtained index inflecting both one's nutritional and inflammatory status. Its clinical role in esophageal squamous cell carcinoma (ESCC) remains still in debate. The aim of this meta-analysis was to assess the prognostic value and the clinical-pathological features of pre-treatment PNI in ESCC patients. METHODS A comprehensive search of online databases (PubMed, Embase, Web of Science) was performed. Studies explored the relationship between pre-treatment PNI and long-term survival of ESCC patients were regarded eligible for this meta-analysis. Outcomes were extracted and synthesized. Hazard ratio (HR) and relative ratio (RR) with 95% confidence interval (CI) were used to evaluate the prognostic value of PNI on long-term survival and association with clinical-pathological features, respectively. The heterogeneity levels and publication bias between studies were also estimated. RESULTS Nine observational studies involving 2276 patients were considered eligible for this meta-analysis. The pooled results showed that low PNI score was significantly correlated with poorer overall survival (OS) of esophageal cancer (pooled HR = 1.418 95%CI: 1.200-1.676, P = .000), poorer recurrence free survival (HR = 1.880 95%CI: 1.207-2.929, P = .005) but not cancer specific survival (CSS) (HR = 1.948 95%CI: 0.544-6.977, P = .306). The PNI value was not related with patient age, sex, depth of tumor invasion, nodular metastasis, and differential grade but the TNM stage (III/IV vs 0/I/II, RR = 1.276, 95% CI 1.146-1.420). CONCLUSIONS Low pre-treatment PNI was significantly related with OS and recurrence free survival but not CSS for ESCC. PNI was a reliable prognostic factor of ESCC, and higher stage ESCC have higher incidence of low PNI.
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Affiliation(s)
- Pengfei Li
- Department of Thoracic Surgery, West China Hospital
| | - Xin Wang
- Department of Thoracic Surgery, West China Hospital
| | - Yutian Lai
- Department of Thoracic Surgery, West China Hospital
| | - Kun Zhou
- Department of Thoracic Surgery, West China Hospital
| | - Yuxin Tang
- West China School of Public Health, Sichuan University, Chengdu, P.R. China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital
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23
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Ni XC, Xu J, Yi Y, Fu YP, Cai XY, Liu G, Huang JL, Gan W, Qiu SJ. Inflammation-nutrition score predicts prognosis of patients with resectable hepatocellular carcinoma. Int J Clin Oncol 2019; 24:825-835. [PMID: 31020447 DOI: 10.1007/s10147-019-01402-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/17/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Various inflammation-based prognostic scores have been associated with poor survival in patients with hepatocellular carcinoma (HCC). METHODS Data were collected retrospectively from 674 HCC patients who underwent curative resection. The correlation between INS (inflammation-nutrition score), BCLC (Barcelona Clinic Liver Cancer) stage and inflammatory indices and overall survival (OS) and disease free survival (DFS) was examined. RESULTS An elevated INS was associated with both tumor and host clinical characteristics. The combination of INS and BCLC stage stratifies OS and DFS from 80% and 65% (INS = 0, stage A) to 0% (INS = 2, stage C). Univariate and multivariate analyses revealed that the INS was an independent predictor for OS and DFS, and was superior to inflammation-based scores. In addition, INS was demonstrated to be a prognostic factor for patients with early stage and had a higher AUC value in comparison with inflammation scores. CONCLUSION This study demonstrates that the INS is an independent marker of poor prognosis in patients with resectable HCC, especially for those with early stage, and it provides complimentary prognostic information to BCLC stage, and may aid in treatment strategy.
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Affiliation(s)
- Xiao-Chun Ni
- General Surgery, Shanghai Ninth People's Hospital, 280 Mohe Road, Shanghai, People's Republic of China
| | - Jie Xu
- Infection Disease, Shanghai Ninth People's Hospital, 280 Mohe Road, Shanghai, People's Republic of China
| | - Yong Yi
- Hepatic Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Yi-Peng Fu
- Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, People's Republic of China
| | - Xiao-Yan Cai
- General Surgery, Shanghai Pudong Gongli Hospital, 219 Miaopu Road, Shanghai, People's Republic of China
| | - Gao Liu
- Hepatic Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Jin-Long Huang
- Hepatic Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Wei Gan
- Hepatic Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Shuang-Jian Qiu
- Hepatic Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
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24
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Lv Y, Zhang J, Liu Z, Tian Y, Liu F. A novel inflammation-based prognostic index for patients with esophageal squamous cell carcinoma: Neutrophil lymphocyte ratio/prealbumin ratio. Medicine (Baltimore) 2019; 98:e14562. [PMID: 30762804 PMCID: PMC6407987 DOI: 10.1097/md.0000000000014562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/09/2019] [Accepted: 01/23/2019] [Indexed: 01/19/2023] Open
Abstract
NLR/Alb (neutrophil lymphocyte ratio/albumin ratio), is a prognostic index for esophageal cancer has been confirmed. Prealbumin (PA) is more sensitive to malnutrition than albumin. A new prognostic index, named neutrophil lymphocyte ratio/prealbumin ratio (NLR/PA), for predicting the survival time in patients with esophageal squamous cell carcinoma (ESCC) was proposed.A retrospective study of 315 cases with ESCC was enrolled. The optimal cut-off values were evaluated by ROC curve (the receiver operating characteristics curve). Pearson correlation analyses were used to calculate the correlations among NLR, Alb, NLR/Alb and NLR/PA. The overall survival (OS) was calculated by Kaplan-Meier method. Cox regression analyses were performed to evaluate the prognostic factors.The optimal cut-off value was 0.01 for NLR/PA according to ROC curve. According to multivariate analyses, TNM stage, NLR, NLR/Alb, NLR/PA were prognostic factors for OS. The AUC area (the area under the receiver operating characteristics curves) of the NLR/PA was higher than the areas of NLR and NLR/Alb for all the patients. The index of NLR/ PA had a higher AUC area than that of the index of NLR or NLR/Alb for patients in stage I-II. But in stage III-IVA, the index of NLR had a higher AUC area than that of the index of NLR/PA or NLR/Alb.The index of NLR/PA is superior to the index of NLR as a prognostic indicator for patients with early stage (stage I-II) ESCC.
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25
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Kudou K, Saeki H, Nakashima Y, Kamori T, Kawazoe T, Haruta Y, Fujimoto Y, Matsuoka H, Sasaki S, Jogo T, Hirose K, Hu Q, Tsuda Y, Kimura K, Ando K, Oki E, Ikeda T, Maehara Y. C-reactive protein/albumin ratio is a poor prognostic factor of esophagogastric junction and upper gastric cancer. J Gastroenterol Hepatol 2019; 34:355-363. [PMID: 30119141 DOI: 10.1111/jgh.14442] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM The C-reactive protein (CRP)/albumin (Alb) ratio has been reported as a novel prognostic marker in several cancers. The objective of this study was to investigate the prognostic value of the CRP/Alb ratio in patients who underwent surgery for adenocarcinoma of the esophagogastric junction (AEG) and upper gastric cancer (UGC). METHODS Data for 144 patients who underwent surgery for AEG and UGC were reviewed. The CRP/Alb ratio, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, Glasgow Prognostic Score, and controlling nutritional status score were calculated, and the relationship between these biomarkers and postoperative prognosis was analyzed. RESULTS The optimal cutoff value of the CRP/Alb ratio was determined to be 0.1. According to the cutoff value of CRP/Alb ratio, patients were divided into two groups (CRP/Alb < 0.1, n = 124; CRP/Alb ≥ 0.1, n = 20). The 5-year recurrence-free survival and overall survival (OS) rates were significantly lower in the patients with the CRP/Alb ratio ≥ 0.1 than in those with the CRP/Alb ratio < 0.1 (recurrence-free survival: 44.9% vs 77.9%, P = 0.0011; OS: 43.4% vs 82.0%, P < 0.0001). In the multivariate analyses, the N-stage, and CRP/Alb ratio ≥ 0.1 were identified as independent predictive factors for OS in patients with AEG and UGC (P = 0.0061 and P = 0.0439, respectively). CONCLUSIONS The CRP/Alb ratio was strongly associated with poor prognosis in patients who underwent surgery for AEG and UGC.
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Affiliation(s)
- Kensuke Kudou
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Endoscopy and Endoscopic Surgery, Fukuoka Dental College, Fukuoka, Japan
| | - Hiroshi Saeki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichiro Nakashima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohiro Kamori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Kawazoe
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Haruta
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshiaki Fujimoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroya Matsuoka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shun Sasaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoko Jogo
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kosuke Hirose
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Qingjiang Hu
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuo Tsuda
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Kimura
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Endoscopy and Endoscopic Surgery, Fukuoka Dental College, Fukuoka, Japan
| | - Koji Ando
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuo Ikeda
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Endoscopy and Endoscopic Surgery, Fukuoka Dental College, Fukuoka, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Surgery, Kyushu Central Hospital, Fukuoka, Japan
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26
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Imperatori L, Giardini D, Latini G, Migliori G, Blasi C, Bunkheila F, Breschi C, Mattioli R, Pelliccioni S, Laurino C, Vadalà M, Palmieri B, Iannitti T. Feasibility single-arm study of a medical device containing Desmodium adscendens and Lithothamnium calcareum combined with chemotherapy in head and neck cancer patients. Cancer Manag Res 2018; 10:5433-5438. [PMID: 30519091 PMCID: PMC6234998 DOI: 10.2147/cmar.s165746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Neoplasms of the head and neck represent approximately 5% of cancers and they require complex multidisciplinary clinical management. Desmodium adscendens (Desmodium) is a plant that possesses anti-allergic, antioxidant and hepatoprotective properties. Lithothamnium calcareum (Lithothamnium) is a calcified seaweed that possesses remineralization properties and the ability to maintain homeostasis. Aim In this single-arm study, we investigated the efficacy of a combination therapy based on Desmovit® which contains Desmodium and Lithothamnium, and chemotherapy in patients with head and neck cancer. Methods Twelve patients with histological or cytological diagnosis of stage IV head and neck cancer were enrolled in this study that was approved by the ethics committee of the Unità Operativa Complessa (UOC) di Oncologia Medica Azienda Ospedaliera Ospedali Riuniti Marche Nord and followed the Declaration of Helsinki guidelines. The patients were monitored by investigation of the performance status according to the Glasgow Prognostic Score (GPS), which evaluates the plasma level of C-reactive protein and albumin levels, and the Eastern Cooperative Oncology Group (ECOG) examination. Pain and fatigue were also monitored using the visual analog scale and visual analog fatigue scale, respectively. All the above parameters were assessed biweekly to week 10. Results GPS, ECOG, and albumin remained stable throughout the study with a trend towards a decrease in GPS and albumin at week 10 post-treatment. Pain significantly improved at week 8 (P<0.05) while fatigue improved at weeks 8 and 10 (all P<0.01). Conclusion We found that chemotherapy, combined with Desmodium and Lithothamnium, improved pain and fatigue in head and neck cancer patients, although we cannot confirm if this was due to Desmodium and Lithothamnium or chemotherapy. The improvement in pain and fatigue was supported by the ECOG performance status remaining stable with the highest score being equal to 2 throughout the study and a trend towards an improvement in GPS performance status and albumin levels.
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Affiliation(s)
- Luca Imperatori
- UOC Oncologia Medica Azienda Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
| | - Damiano Giardini
- UOC Otorinolaringoiatria Az. Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
| | - Gino Latini
- UOC Otorinolaringoiatria Az. Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
| | - Giuseppe Migliori
- UOC Otorinolaringoiatria Az. Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
| | - Claudio Blasi
- UOC Radioterapia Az. Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
| | - Feisal Bunkheila
- UOC Radioterapia Az. Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
| | - Cesare Breschi
- UOC Anestesia e Rianimazione Az. Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
| | - Rodolfo Mattioli
- UOC Oncologia Medica Azienda Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
| | - Silvia Pelliccioni
- UOC Oncologia Medica Azienda Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
| | - Carmen Laurino
- Department of General Surgery and Surgical Specialties, Surgical Clinic, University of Modena and Reggio Emilia Medical School, Modena, Italy
| | - Maria Vadalà
- Department of General Surgery and Surgical Specialties, Surgical Clinic, University of Modena and Reggio Emilia Medical School, Modena, Italy
| | - Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, Surgical Clinic, University of Modena and Reggio Emilia Medical School, Modena, Italy
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27
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Zhou YC, Chen LL, Xu HB, Sun Q, Zhang Q, Cai HF, Jiang H. Aging-related prognosis analysis of definitive radiotherapy for very elderly esophageal cancer. Cancer Med 2018; 7:1837-1844. [PMID: 29608256 PMCID: PMC5943545 DOI: 10.1002/cam4.1456] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/24/2018] [Accepted: 02/28/2018] [Indexed: 01/19/2023] Open
Abstract
Because of the exclusion for the patients more than 75 years (very elderly patients) in many clinical trials of esophageal cancer (EC), there is no consensus on prognosis and treatment for this population. We aim to evaluate the outcomes and aging‐related prognostic factors of definitive radiotherapy (RT) for very elderly EC patients. We retrospectively analyzed 149 very elderly EC patients consecutively treated between January 2015 and June 2016 by definitive intensity‐modulated radiotherapy (IMRT) with or without chemotherapy. The clinical outcome and toxicities were assessed, and the potential prognostic factors, such as nutritional risk index (NRI) and neutrophil–lymphocyte ratio (NLR), were analyzed statistically. The median follow‐up time for survivors was 22.5 months. The 2‐year overall survival (OS), local–regional failure‐free survival (LRFFS), and distant metastasis‐free survival (DMFS) were 51.6%, 54.7%, and 85.2%, respectively. Independent predictors for poorer OS were higher American Joint Committee on Cancer (AJCC) stage, lower NRI, and higher NLR value before RT. Meanwhile, the total dose (cutoff value 60 Gy) of planning gross tumor volume (PGTV) and chemotherapy was also identified as independent prognostic indicator for LRFFS and DMFS, respectively. 72 patients had treatment failure and 58 (80.6%), 6 (8.3%), and 18 (25.0%) patients had experienced local, regional, and distant failure, respectively. Few severe toxicities were observed. The conservative definitive RT with modern technique was effective for very elderly EC patients in short term with low rate and tolerable toxicities. Local residue or recurrence was the most common failure pattern. The aging‐related prognostic factors concerned nutrition and immune, such as NRI and NLR before RT, should be considered for use in future clinical practice.
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Affiliation(s)
- Yong-Chun Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, No. 287, Chang Huai Road, Bengbu, 233000, China
| | - Li-Li Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, No. 287, Chang Huai Road, Bengbu, 233000, China
| | - Hong-Bo Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, No. 287, Chang Huai Road, Bengbu, 233000, China
| | - Qian Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, No. 287, Chang Huai Road, Bengbu, 233000, China
| | - Qi Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, No. 287, Chang Huai Road, Bengbu, 233000, China
| | - Han-Fei Cai
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, No. 287, Chang Huai Road, Bengbu, 233000, China
| | - Hao Jiang
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, No. 287, Chang Huai Road, Bengbu, 233000, China
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