Cancer Management and Research (May 2020)

A Predictive Scoring System Based on Inflammatory and Tumor Markers for Gastric Cancer Patients Undergoing Curative Resection

  • Feng LW,
  • Li J,
  • Liang LF,
  • Guo QQ,
  • Li J,
  • Wu J,
  • Zhang PH,
  • Qin YR

Journal volume & issue
Vol. Volume 12
pp. 3937 – 3948

Abstract

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Li-Wen Feng,1 Jing Li,1 Li-Feng Liang,2 Qian-Qian Guo,1 Jiang Li,3 Jian Wu,3 Pei-Hua Zhang,3 Yan-Ru Qin1 1Department of Oncology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, People’s Republic of China; 2Department of Internal Medicine, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, People’s Republic of China; 3Preventive Medicine, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of ChinaCorrespondence: Yan-Ru QinDepartment of Oncology, Zhengzhou University First Affiliated Hospital, No. 1 Jianshe East Road, Erqi District, Zhengzhou 450052, Henan Province, People’s Republic of ChinaEmail [email protected]: Inflammation is closely associated with prognosis in gastric cancer (GC). We aimed to assess the predictive value of existing inflammatory and tumor markers in GC, to establish a systemic score based on valuable predictors for early risk stratification of patients, and to create a nomogram for individual risk prediction.Patients and Methods: We retrospectively analyzed 401 GC patients who underwent curative gastrectomy from 2007 to 2016.Results: Through univariate and multivariate survival analysis, age (> 60 years), depth of invasion (pT3– 4), lymph node invasion (pN1– 3), histologic classification (poor), adjuvant chemotherapy (no), albumin fibrinogen ratio (AFR) (< 13.33), and carbohydrate antigen 19-9 (CA19-9) (> 27 U/mL) independently indicated inferior disease-free survival (DFS). In addition, depth of invasion, lymph node invasion, histologic classification, adjuvant chemotherapy, AFR, and CA19-9 were incorporated in the prediction of cancer-specific survival (CSS). A combined AFR and CA19-9 prognostic score (CACPS) was established. Lower AFR (< 13.33) and higher CA19-9 (> 27 U/mL) were allocated 1 point each in the CACPS (range, 0– 2). CACPS can be used as an independent predictor for DFS and CSS in multivariate analysis (for DFS: CACPS 1: HR=2.039, 95% CI: 1.357– 3.065, P=0.001; CACPS 2: HR=2.419, 95% CI: 1.397– 4.186, P=0.002; for CSS: CACPS 1: HR=2.035, 95% CI: 1.292– 3.205, P=0.002; CACPS 2: HR=2.255, 95% CI: 1.252– 4.059, P=0.007), with a higher CACPS indicating poor survival according to Kaplan–Meier curves (both P< 0.001). Moreover, a nomogram for DFS and CSS was generated using the significant characteristics in the multivariate analysis, which exhibited high accuracy (for DFS: C-index=0.743, 95% CI: 0.698– 0.788; for CSS: C-index=0.766, 95% CI: 0.718– 0.814) versus tumor–node–metastasis staging (for DFS: C-index=0.692, 95% CI: 0.650– 0.734; for CSS: C-index=0.720, 95% CI: 0.675– 0.764).Conclusion: Preoperative CACPS exhibited high accuracy in predicting prognosis for GC patients who underwent curative resection.Keywords: albumin fibrinogen ratio, carbohydrate antigen 19-9, prognosis

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