The combination of preoperative fibrinogen and neutrophil-lymphocyte ratio is a predictive prognostic factor in esophagogastric junction and upper gastric cancer

Combining systemic inflammatory response index and albumin fibrinogen ratio to predict early serious complications and prognosis after resectable gastric cancer

BACKGROUND

Gastric cancer has a high incidence and fatality rate, and surgery is the preferred course of treatment. Nonetheless, patient survival rates are still low, and the incidence of major postoperative complications cannot be disregarded. The systemic inflammatory response, nutritional level, and coagulation status are key factors affecting the postoperative recovery and prognosis of gastric cancer patients. The systemic inflammatory response index (SIRI) and the albumin fibrinogen ratio (AFR) are two valuable comprehensive indicators of the severity and prognosis of systemic inflammation in various medical conditions.

AIM

To assess the clinical importance and prognostic significance of the SIRI scores and the AFR on early postoperative outcomes in patients undergoing radical gastric cancer surgery.

METHODS

We conducted a retrospective analysis of the clinicopathological characteristics and relevant laboratory indices of 568 gastric cancer patients from January 2018 to December 2019. We calculated and compared two indicators of inflammation and then examined the diagnostic ability of combined SIRI and AFR values for serious early postoperative complications. We scored the patients and categorized them into three groups based on their SIRI and AFR levels. COX analysis was used to compare the three groups of patients the prognostic value of various preoperative SIRI-AFR scores for 5-year overall survival (OS) and disease-free survival (DFS).

RESULTS

SIRI-AFR scores were an independent risk factor for prognosis [OS: P = 0.004; hazards ratio (HR) = 3.134; DFS: P < 0.001; HR = 3.543] and had the highest diagnostic power (area under the curve: 0.779; 95% confidence interval: 0.737-0.820) for early serious complications in patients with gastric cancer. The tumor-node-metastasis stage (P = 0.001), perioperative transfusion (P = 0.044), positive carcinoembryonic antigen (P = 0.014) findings, and major postoperative complications (P = 0.011) were factors associated with prognosis.

CONCLUSION

Preoperative SIRI and AFR values were significantly associated with early postoperative survival and the occurrence of severe complications in gastric cancer patients.

Clinical significance of systemic inflammation response index and platelet-lymphocyte ratio in patients with adenocarcinoma of the esophagogastric junction and upper gastric cancer

Background

Tumor immunity plays an important role in assessing the tumor progression. The purpose of this study was to investigate the prognostic value of combined systemic inflammation response index (SIRI) and platelet-lymphocyte ratio (PLR) of gastroesophageal junction cancer (AEG) and upper gastric cancer (UGC) patients.

Methods

In this retrospective study, patients from 2003 to 2014 were divided into training and validation sets. The prognostic accuracy of each variable was compared using time-independent ROC analysis. The scoring system was calculated by cut-off values of SIRI and PLR in 5-year. Kaplan-Meier and Log-rank tests were used to analyze overall survival (OS). Chi-square test was used to analyze the association between clinical characteristics and the scoring system. Univariate and multivariate analyses based on the competitive risk regression model were used to analyze independent predictors of death due to AGC and UGC. R software was used to construct the Nomogram model of risk assessment.

Results

Patients with SIRI-PLR = 2 had worse survival time than those with 0 and 1 (P < 0.001) and more suitable for postoperative adjuvant chemotherapy (P = 0.002). High PLR patients were more suitable for proximal gastrectomy (P = 0.049). SIRI-PLR were independent predictors in training set (P < 0.001), which could be combined with age, pTNM stage and postoperative chemotherapy to construct Nomogram for predicting OS.

Conclusions

Preoperative SIRI-PLR score was an independent predictor for patients with AEG and UGC. The Nomogram model constructed by age, SIRI-PLR, pTNM stage and postoperative chemotherapy can correctly predict the prognosis of patients.

Occludin: a gatekeeper of brain Infection by HIV-1

Compromised structure and function of the blood-brain barrier (BBB) is one of the pathological hallmarks of brain infection by HIV-1. BBB damage during HIV-1 infection has been associated with modified expression of tight junction (TJ) proteins, including occludin. Recent evidence indicated occludin as a redox-sensitive, multifunctional protein that can act as both an NADH oxidase and influence cellular metabolism through AMPK kinase. One of the newly identified functions of occludin is its involvement in regulating HIV-1 infection. Studies suggest that occludin expression levels and the rate of HIV-1 infection share a reverse, bidirectional relationship; however, the mechanisms of this relationship are unclear. In this review, we describe the pathways involved in the regulation of HIV-1 infection by occludin. We propose that occludin may serve as a potential therapeutic target to control HIV-1 infection and to improve the lives of people living with HIV-1.

A Nomogram Based on Nutrition-Related Indicators and Computed Tomography Imaging Features for Predicting Preoperative Lymph Node Metastasis in Curatively Resected Esophagogastric Junction Adenocarcinoma

BACKGROUNDS

Preoperative noninvasive tools to predict pretreatment lymph node metastasis (PLNM) status accurately for esophagogastric junction adenocarcinoma (EJA) are few. Thus, the authors aimed to construct a nomogram for predicting PLNM in curatively resected EJA.

METHODS

This study enrolled 638 EJA patients who received curative surgery resection and divided them randomly (7:3) into training and validation groups. For nomogram construction, 26 candidate parameters involving 21 preoperative clinical laboratory blood nutrition-related indicators, computed tomography (CT)-reported tumor size, CT-reported PLNM, gender, age, and body mass index were screened.

RESULTS

In the training group, Lasso regression included nine nutrition-related blood indicators in the PLNM-prediction nomogram. The PLNM prediction nomogram yielded an area under the receiver operating characteristic (ROC) curve of 0.741 (95 % confidence interval [CI], 0.697-0.781), which was better than that of the CT-reported PLNM (0.635; 95% CI 0.588-0.680; p < 0.0001). Application of the nomogram in the validation cohort still gave good discrimination (0.725 [95% CI 0.658-0.785] vs 0.634 [95% CI 0.563-0.700]; p = 0.0042). Good calibration and a net benefit were observed in both groups.

CONCLUSIONS

This study presented a nomogram incorporating preoperative nutrition-related blood indicators and CT imaging features that might be used as a convenient tool to facilitate the preoperative individualized prediction of PLNM for patients with curatively resected EJA.

Prognostic analysis of the plasma fibrinogen combined with neutrophil-to-lymphocyte ratio in patients with non-small cell lung cancer after radical resection

BACKGROUND

To investigate the correlation between the fibrinogen combined with neutrophil-to-lymphocyte ratio (F-NLR) and the clinicopathologic features of non-small cell lung cancer (NSCLC) patients who underwent radical resection.

METHODS

This study reviewed the medical records of 289 patients with NSCLC who underwent radical resection. The patients were stratified into three groups based on F-NLR as follows: patients with low NLR and fibrinogen were group A, patients with high NLR or fibrinogen were group B, and patients with high NLR and fibrinogen were group C. Receiver operating characteristic curve and Youden index were used to determine the cutoff value of the NLR and fibrinogen. Survival curves were described by Kaplan-Meier method and compared by log-rank test. The univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the prognostic factors.

RESULTS

A value of 3.19 was taken as the optimal cutoff value of NLR in this study. A value of 309 was used as the optimal cutoff value of fibrinogen. Cox multivariate analysis showed that tumor, nodes, metastasis (TNM) stage and F-NLR were independent prognostic factors affecting the survival rate of patients. The first-, third-, and fifth-year survival rates in group A were 99.2%, 96.6%, and 95.0%, respectively. The first-, third-, and fifth-year survival rates in group B were 98.4%, 76.6%, and 63.2%, respectively. The first-, third-, and fifth-year survival rates in group C were 91.3%, 41.1%, and 22.8%, respectively. F-NLR was significantly correlated with overall survival in patients with NSCLC (p < 0.001).

CONCLUSIONS

The F-NLR level is markedly related to the prognosis of patients with NSCLC undergoing radical surgery. Therefore, closer attention should be given to patients with NSCLC with a high F-NLR before surgery to provide postoperative adjuvant therapy.

Prediction Model and Nomogram of Early Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation Based on Logistic Regression Analysis

The purpose of this study was to screen for high-risk factors leading to the early recurrence of hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) and to construct a prediction model and nomogram. This retrospective study included 108 patients with primary HCC who underwent RFA treatment at the Harbin Medical University Cancer Hospital between January 2018 and June 2019. Four risk factors were screened for using univariate and multivariate logistic regression analyses: number of tumors (hazard ratio [HR] = 14.684, 95% confidence interval [CI]: 1.099-196.215, p = 0.042), neutrophil-to-lymphocyte ratio (NLR) (HR = 2.178, 95% CI: 1.003-4.730, p = 0.049), contrast-enhanced ultrasound (CEUS) performance (HR = 6.482, 95% CI: 1.161-36.184, p = 0.033) and α-fetoprotein (AFP) level (HR = 1.001, 95% CI: 1.000-1.003, p = 0.040). We established a prediction model: Logit(p) = -3.096 + 2.827 × (number of tumors >1 = 1) + 1.851 × (CEUS revealing rapid enhancement of blood flow signal in the arterial phase and clearance in the portal phase = 1) + 1.941 × (NLR >1.55 = 1) + 0.257 × (AFP >32.545 = 1). Through clinical decision curve analysis, the model's threshold was 0.043-0.873, indicating a high clinical value. Patients with a high AFP level, typical CEUS enhancement pattern, multiple tumors and elevated NLR are more likely to relapse early.

A model integrated fibrinogen and D-dimer for prediction of hepatocellular carcinoma recurrence following liver transplantation: a multicentre study

BACKGROUND

We aimed to investigate whether D-dimer and fibrinogen levels could predict prognosis of patients with hepatocellular carcinoma (HCC) following liver transplantation.

METHODS

From January 2015 to January 2020, we conducted a study on patients with hepatitis B-related liver cancer. Two hundred seventy (270) liver transplant recipients were recruited. Considering D-dimer and plasma fibrinogen levels, a model was established to predict liver cancer recurrence following liver transplantation. Subsequent verification was performed on a validation cohort of 295 recipients from two other hospitals.

RESULTS

Elevated D-dimer and plasma fibrinogen levels demonstrated independent correlation between overall survival and tumour-free survival among patients with HCC who underwent liver transplantation. Those who had preoperative fibrinogen ≥2.27 g/L had significantly reduced overall survival and tumour-free survival than those who had preoperative fibrinogen <2.27 g/L, in the discovery cohort. Recipients with increased risk had preoperative plasma D-dimer ≥2400 µg/L. The model was: Y= logit (P) =0.91* fibrinogen concentration +0.967* D-dimer +0.585* alpha-fetoprotein +1.623* Milan criteria +0.68* microvascular invasion -3.159. At a cut-off score of -1.524, the validation cohort had area under curve values of 0.764 and 0.828 respectively; analysis of this data optimised predictive performance for overall and tumour-free survival.

CONCLUSIONS

For patients who have undergone liver transplantation for HCC, preoperative D-dimer and fibrinogen levels independently predicted key outcomes such as overall survival and tumour-free survival.

The Ratio of the Hemoglobin to Red Cell Distribution Width Combined with the Ratio of Platelets to Lymphocytes Can Predict the Survival of Patients with Gastric Cancer Liver Metastasis

Background

Hemoglobin/red cell distribution width (HR) and platelet/lymphocyte (PLR) ratios are considered effective prognostic markers in various cancers. We have proposed a new prognostic parameter: HR+PLR. The aim of this study is to explore the prognostic value of the HR+PLR scoring system in patients with gastric cancer liver metastasis.

Methods

This study retrospectively analyzed the clinical data of 306 patients with gastric cancer liver metastases admitted to our hospital from 2007 to 2014. According to the size of HR value and PLR value, we will divide the patients into three groups, namely, HR+PLR: (1) 0 points: HR > 1.02 and PLR < 128; (2) 1 point: HR > 1.02 and PLR > 128 and HR < 1.02 and PLR < 128; and (3) 2 points: HR < 1.02 and PLR > 128.

Results

The HR+PLR score was statistically different from age (P = 0.049), T stage (P < 0.001), N stage (P = 0.017), number of liver metastases (P = 0.018), gastrectomy (P < 0.001), hepatectomy (P = 0.001), peritoneal metastasis (P = 0.012), prognostic nutritional index (PNI) (P = 0.028), and neutrophil/lymphocyte ratio (NLR) (P = 0.045). The HR+PLR scoring system has a higher area under the ROC curve (AUC value) than PNI, PLR, HR, and PLR (AUC = 0.798, P < 0.001). In multivariate analysis, gastrectomy (P = 0.001), hepatectomy (P < 0.001), chemotherapy (P = 0.014), and HR+PLR score (P < 0.001) were considered independent prognostic factors.

Conclusion

For patients with gastric cancer liver metastasis, the HR+PLR score is a simple, reliable, and economic prognostic marker.

Clinical significance of peripheral blood-derived inflammation markers in advanced gastric cancer after radical resection

Background

The prognostic significance of peripheral blood-derived inflammation markers in patients with gastric cancer (GC) has not been elucidated. This study aimed to investigate the relationship between systemic inflammatory markers and GC prognosis.

Methods

A prospective observational cohort study involving 598 patients was conducted to analyze the prognosis of GC based on systemic inflammatory markers. The following peripheral blood-derived inflammation markers were evaluated: the neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), systemic immune-inflammation index (SII), C-reactive protein/albumin (CRP/Alb) ratio, Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), prognostic nutrition index (PNI), and prognostic index (PI). The receiver operating characteristics (ROC) curve and the Youden index were used to determine the optimal cutoff values. Univariate and multivariate analysis of prognostic factors was conducted accordingly.

Results

The optimal cutoff values of the PNI, fibrinogen, NLR, PLR, SII, and CRP/Alb were 49.5, 397 ng/dl, 2.5, 154, 556, and 0.05, respectively. Multivariate analysis showed that age, PLR, TNM stage, and chemotherapy were the independent prognostic factors for advanced gastric cancer (AGC). Adjuvant chemotherapy improved the long-term prognosis of patients with PLR ≥154, but chemotherapy had no significant effect on the survival of patients with PLR < 154.

Conclusions

Our findings show that higher PLR (≥154) is an independent risk factor for poor prognosis in GC patients. Besides, PLR can predict adjuvant chemotherapy (oxaliplatin/5-fluorouracil combination) response in patients with GC after surgery.

Blood-based Markers in the Prognostic Prediction of Esophagogastric Junction Cancer

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.