Sodium to globulin ratio as a prognostic factor for patients with advanced gastric cancer

Comprehensive analysis of the prognostic role of laboratory indices in advanced lung cancer patients

OBJECTIVE

Lung cancer, the most common cause of cancer-related death, is diagnosed mostly in advanced stages, and 5-year survival is approximately 5.8%. It is critical to identify reliable prognostic factors to optimize treatment responses, guide therapeutic strategies and pave the way to new research. In this study, we aimed to investigate the strongest prognostic factors for advanced non-small cell lung cancer (NSCLC).

METHODS

We retrospectively analyzed 278 patients with NSCLC. We evaluated the association between potential prognostic factors and overall survival (OS) times using Kaplan-Meier analysis and Cox regression analysis.

RESULTS

The median OS in all patients was 15.3 months. In univariate analysis, gender, histologic type, performance status, immunotherapy, radiotherapy, hemoglobin level, serum albumin, sodium-globulin ratio (SGR), neutrophil-lymphocyte ratio (NLR), systemic immune inflammation index (SII), hemoglobin-albumin-lymphocyte-platelet score (HALP), and advanced lung cancer index (ALI) were associated with survival. Models were established for multivariate analyses. In the models, NLR, SGR, HALP, immunotherapy, radiotherapy, and Eastern Cooperative Oncology Group (ECOG) performance status showed independent prognostic features (p < 0.001, p = 0.003, p = 0.002, p < 0.001, p = 0.010, and p = 0.025, respectively). In addition, in the subgroup analysis, prognostic indexes (NLR, SGR, and HALP) were found to have a prognostic effect on survival in multiple subgroups.

CONCLUSIONS

Pretreatment NLR, SGR, HALP, immunotherapy, radiotherapy, and ECOG performance status are independent prognostic factors for advanced NSCLC patients. These prognostic factors can be used in clinical practice as easily accessible, simple, and useful tools for clinicians.

High level of C3 is associated with Th2 immune response and liver fibrosis in patients with schistosomiasis

Long-term infection of schistosomiasis will seriously affect the liver health of patients. The serum of 334 chronic Schistosoma japonicum patients and 149 healthy volunteers was collected. Compared with heathy people, the level of C4 (complement 4) was increased, and the level of C3 (complement 3) was in an obvious skewed distribution. ELISA was performed to detect the serum cytokines, the results showed that the levels of IFN-γ (interferon-γ), IL (interleukin)-2 and TNF-α (tumour necrosis factor-α) were reduced, while the levels of Th2 cytokines (IL-4, IL-6 and IL-10) were increased. In the serum of patients with high C3, the secretion of HA (hyaluronic acid), LN (laminin), IV-C (type IV collagen) and PCIII (type III procollagen) were increased, the activation of hepatic stellate cells was promoted. Exogenous human recombinant C3 made mice liver structure of the mice damaged and collagen deposition. IFN-γ and IFN-γ/IL-4 were decreased, while HA, LN, PCIII and IV-C were increased, and the expressions of α-SMA and TGF-β1 in liver tissues were up-regulated. However, the addition of IFN-γ partially reversed the effect of C3 on promoting fibrosis. High level of C3 is associated with Th2 immune response and liver fibrosis in patients with schistosomiasis.

The predictive value of the preoperative albumin-to-fibrinogen ratio for postoperative hospital length of stay in liver cancer patients

BACKGROUND

Hepatocellular carcinoma (HCC) is a significant global health burden, with postoperative hospital length of stay (LOS) impacting patient outcomes and healthcare costs. Existing nutritional, inflammatory, and coagulation indices can predict LOS, with particular interest in albumin, fibrinogen, and D-dimer. This study investigates the predictive value of preoperative albumin-to-fibrinogen ratio (AFR) and albumin-to-D-dimer ratio (ADR) for postoperative LOS in HCC patients.

METHODS

This retrospective study involved 462 adult HCC patients who underwent partial hepatic lesion excision between February 2016 and August 2022. We analyzed demographic and clinical data, including preoperative blood samples, surgical approach, and LOS. The primary outcome measure was LOS, calculated from the date of surgery to the date of hospital discharge. Preoperative AFR and ADR were calculated. The ROC curves determined optimal cutoff points. The Cox proportional hazards model, Kaplan-Meier method, and the log-rank test were used for statistical analysis.

RESULTS

The study established an optimal AFR cutoff value of 15.474, with a higher AUC value than ADR, indicating superior predictive potential for postoperative LOS. Participants with high-AFR (AFR > 15.474) had a shorter median LOS (13 vs. 15 days, p < 0.001) compared to those with low-AFR (AFR ≤15.474). Multivariate analysis revealed high-AFR (HR: 1.99; p < 0.001) as a positive influence on LOS reduction, whereas Child-Pugh rated as B (HR: 0.49; p < 0.001), laparotomy (HR: 0.37; p < 0.001) and total bilirubin >20.5 μmol/L (HR: 0.58; p < 0.001) negatively impacted LOS reduction. Subgroup analysis confirmed AFR's predictive ability for patients experiencing reduced or prolonged LOS due to Child-Pugh score, surgical methods, and total bilirubin concentrations. Even within normal albumin and fibrinogen levels, patients with high-AFR exhibited a shorter LOS (all p < 0.001).

CONCLUSIONS

Our findings underscore the value of the AFR as a reliable predictor of LOS in HCC patients. An AFR greater than 15.474 consistently correlated with a shorter LOS, suggesting its potential clinical utility in guiding perioperative management and resource allocation in HCC patients.

A novel prediction model for pathological complete response based on clinical and blood parameters in locally advanced rectal cancer

Background

The aim of this study was to investigate whether clinical and blood parameters can be used for predicting pathological complete response (pCR) to neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC).

Methods

We retrospectively enrolled 226 patients with LARC [allocated in a 7:3 ratio to a training (n = 158) or validation (n = 68) cohort] who received nCRT before radical surgery. Backward stepwise logistic regression was performed to identify clinical and blood parameters associated with achieving pCR. Models based on clinical parameters (CP), blood parameters (BP), and clinical-blood parameters (CBP) were constructed for comparison with previously reported Tan's model. The performance of the four models was evaluated by receiver operating characteristic (ROC) curve analysis, calibration, and decision curve analysis (DCA) in both cohorts. A dynamic nomogram was constructed for the presentation of the best model.

Results

The CP and BP models based on multivariate logistic regression analysis showed that interval, Grade, CEA and fibrinogen-albumin ratio index (FARI), sodium-to-globulin ratio (SGR) were the independent clinical and blood predictors for achieving pCR, respectively. The area under the ROC curve of the CBP model achieved a score of 0.818 and 0.752 in both cohorts, better than CP (0.762 and 0.589), BP (0.695 and 0.718), Tan (0.738 and 0.552). CBP also showed better calibration and DCA than other models in both cohorts. Moreover, CBP revealed significant improvement compared with other models in training cohort (P < 0.05), and CBP showed significant improvement compared with CP and Tan's model in validation cohort (P < 0.05).

Conclusion

We demonstrated that CBP predicting model have potential in predicting pCR to nCRT in patient with LARC.

Construction and validation of a biochemical signature to predict the prognosis and the benefit of induction chemotherapy in patients with nasopharyngeal carcinoma

This study aimed to develop and validate a biochemical signature for predicting the prognosis of patients with nasopharyngeal carcinoma (NPC) and explore roles of the constructed signature for screening optimal candidates for induction chemotherapy (IC). The biochemical signature was constructed based on a retrospective cohort of 3742 patients from January 2008 to December 2010; 2078 patients from prospective studies from January 2011 to December 2012 and 2153 patients from January 2013 to December 2016 served as validation cohort A and validation cohort B. Overall survival (OS) was the primary endpoint. The least absolute shrinkage and selection operator coefficients on the Cox regression model were calculated to construct the prediction model with the data of 33 biochemical indicators. A total of six prognostic indicators, including sodium, alkaline phosphatase, lactate dehydrogenase, albumin, indirect bilirubin, and cystatin-C, were screened for constructing the biochemical signature. The patients were divided into low-risk and high-risk groups using an optimal cut-off value of 0.823. The patients in high-risk group had significantly lower OS and distant metastasis-free survival (DMFS) compared with patients in low-risk group in three cohorts (P < 0.05). Furthermore, among patients with high-risk scores in the combined cohort, the addition of IC to CCRT further improved their OS and DMFS, whereas patients with low-risk scores did not benefit from IC. Our study developed and validated a clinically useful biochemical signature that could predict the survival outcomes in NPC patients. This signature can help clinicians design personalized treatment strategies.

Prognostic Value of Albumin to D-Dimer Ratio in Advanced Gastric Cancer

Gastric cancer (GC) is one of the most common malignancies worldwide. Notably, patients with advanced GC have a poor prognosis and quality of life, prompting the need for further studies on its prognostic markers. Among these, albumin and D-dimer are often used as prognostic factors in the prediction of a variety of tumors. Moreover, the albumin to D-dimer ratio (ADR) may be an improved predictor of chemotherapy effect and survival compared to albumin and D-dimer alone, but few studies have investigated this issue. Thus, we explored the relationship between pretreatment ADR and prognosis in advanced GC treated with first-line chemotherapy. A total of 247 advanced unresectable GC patients treated with first-line chemotherapy were retrospectively included. The cut-off value for ADR was determined using the receiver operating characteristic (ROC) curve. The ADR had a cut-off value of 41.64. Compared to albumin and D-dimer alone, ADR had the highest area under curve (AUC) value (AUC = 0.730), followed by albumin (AUC = 0.659) and D-dimer (AUC = 0.719). Additionally, we found that patients with a low ADR (<41.64) had a lower disease control rate (77.9% vs. 92.5%, P < 0.01), shorter overall survival (OS) (271 vs. 389 days), and shorter progression-free survival (PFS) (118 vs. 192 days) than patients with a high ADR (≥41.64). Similar results were also found on subgroup analysis, and ADR was found to be an independent advanced GC prognostic factor on multivariate analysis (all P < 0.001). Low ADR was found to be correlated with poor therapeutic effects of chemotherapy and shortened OS and PFS. Therefore, pretreatment ADR may be a useful tool for predicting the effect of chemotherapy and prognosis in advanced GC patients treated with first-line chemotherapy.