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Preoperative NUn score serves as a robust predictor of overall and disease-specific survivals following radical surgery for gastric cancer

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Abstract

Purpose

Methods to preoperatively stratify oncological risks associated with gastric cancer (GC) are limited. Host inflammatory parameters, i.e., serum C-reactive protein (CRP) and albumin levels, are known to be associated with outcomes. We examined the relationships between disease-specific mortality and four CRP-albumin–based indices (CRP-albumin ratio [CAR], modified Glasgow prognostic score [mGPS], Osaka prognostic score [OPS], and NUn score) preoperatively measured in cases with resectable GC.

Methods

Survival outcomes of 1290 consecutive GC patients with oncological gastrectomy were reviewed. Predictive significances of preoperative CAR, mGPS, OPS, and NUn scores were assessed with time-dependent receiver operating characteristic curves and Cox regression analyses.

Results

Median follow-up was 107 months. Area under the curve for predicting overall and disease-specific survivals (OS/DSS) for the preoperative NUn score was clearly superior to those of the other parameters. On univariate Cox regression analysis, preoperative CAR, mGPS, OPS, and the NUn score all correlated significantly with OS/DSS. On multivariate Cox regression analysis, the preoperative NUn score, as a continuous variable, showed an independent relationship with OS (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.16–1.50, per 1-unit increase, P < 0.001) and even DSS (HR 1.23, 95% CI 1.02–1.49, P = 0.032). The other three markers failed to maintain independence for DSS.

Conclusions

Preoperative NUn scores are stably associated with outcomes, including disease-specific mortality, possibly serving as a simple measure to define the likelihood of progression to systemic disease after meticulous surgery for GC, which may contribute to identifying patients who would benefit from additional modalities.

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Data availability

The present data are not available for other studies.

Abbreviations

CAR:

C-reactive protein to albumin ratio

CRP:

C-reactive protein

DSS:

Disease-specific survival

GC:

Gastric cancer

mGPS:

Modified Glasgow prognostic score

NLR:

Neutrophil-to-lymphocyte ratio

OPS:

Osaka prognostic score

OS:

Overall survival

PLR:

Platelet-to-lymphocyte ratio

ROC:

Receiver operating characteristic

References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A et al (2021) Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71(3):209–249

    Article  PubMed  Google Scholar 

  2. Morgan E, Arnold M, Camargo MC, Gini A, Kunzmann AT, Matsuda T et al (2022) The current and future incidence and mortality of gastric cancer in 185 countries, 2020–2040: a population-based modelling study. EClinicalMedicine 47:101404

  3. Goetze OT, Al-Batran SE, Chevallay M, Mönig SP (2018) Multimodal treatment in locally advanced gastric cancer. Updates Surg 70(2):173–179

    Article  PubMed  Google Scholar 

  4. Oñate-Ocaña LF, Aiello-Crocifoglio V, Gallardo-Rincón D, Herrera-Goepfert R, Brom-Valladares R, Carrillo JF et al (2007) Serum albumin as a significant prognostic factor for patients with gastric carcinoma. Ann Surg Oncol 14(2):381–389

    Article  PubMed  Google Scholar 

  5. Saito H, Kono Y, Murakami Y, Shishido Y, Kuroda H, Matsunaga T et al (2018) Prognostic significance of the preoperative ratio of c-reactive protein to albumin and neutrophil-lymphocyte ratio in gastric cancer patients. World J Surg 42(6):1819–1825

    Article  PubMed  Google Scholar 

  6. Jiang X, Hiki N, Nunobe S, Kumagai K, Kubota T, Aikou S et al (2012) Prognostic importance of the inflammation-based Glasgow prognostic score in patients with gastric cancer. Br J Cancer 107(2):275–279

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Fujino S, Myoshi N, Saso K, Sasaki M, Ishikawa S, Takahashi Y et al (2020) The inflammation-nutrition score supports the prognostic prediction of the TNM stage for colorectal cancer patients after curative resection. Surg Today 50(2):163–170

    Article  CAS  PubMed  Google Scholar 

  8. Noble F, Curtis N, Harris S, Kelly JJ, Bailey IS, Byrne JP et al (2012) Risk assessment using a novel score to predict anastomotic leak and major complications after oesophageal resection. J Gastrointest Surg 16(6):1083–1095

    Article  PubMed  Google Scholar 

  9. Yago A, Haruta S, Ueno M, Hamada Y, Ogawa Y, Ohkura Y et al (2021) Adequate period of surveillance in each stage for curatively resected gastric cancer: analyzing the time and rates of recurrence. Gastric Cancer 24(3):752–761

    Article  PubMed  Google Scholar 

  10. Brierley JD, Gospodarowicz MK, Wittekind C (2017) TNM classification of malignant tumours, 8th edn. Wiley-Blackwell, Oxford, UK

    Google Scholar 

  11. Lauren P (1965) The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. An attempt at a histo-clinical classification. Acta Pathol Microbiol Scand 64:31–49

    Article  CAS  PubMed  Google Scholar 

  12. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  13. Japanese Gastric Cancer Association (2021) Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 24(1):1–21

    Article  Google Scholar 

  14. Kattan MW, Karpeh MS, Mazumdar M, Brennan MF (2003) Postoperative nomogram for disease-specific survival after an R0 resection for gastric carcinoma. J Clin Oncol 21(19):3647–3650

    Article  PubMed  Google Scholar 

  15. Katai H, Ishikawa T, Akazawa K, Isobe Y, Miyashiro I, Oda I et al (2018) Five-year survival analysis of surgically resected gastric cancer cases in Japan: a retrospective analysis of more than 100,000 patients from the nationwide registry of the Japanese Gastric Cancer Association (2001–2007). Gastric Cancer 21(1):144–154

    Article  PubMed  Google Scholar 

  16. Kubota T, Hiki N, Sano T, Nomura S, Nunobe S, Kumagai K et al (2014) Prognostic significance of complications after curative surgery for gastric cancer. Ann Surg Oncol 21(3):891–898

    Article  PubMed  Google Scholar 

  17. Altman DG, Royston P (2006) The cost of dichotomising continuous variables. BMJ 332(7549):1080

    Article  PubMed  PubMed Central  Google Scholar 

  18. Alsina M, Arrazubi V, Diez M, Tabernero J (2023) Current developments in gastric cancer: from molecular profiling to treatment strategy. Nat Rev Gastroenterol Hepatol 20(3):155–170

    Article  CAS  PubMed  Google Scholar 

  19. Dvorak HF (1986) Tumors: wounds that do not heal. Similarities between tumor stroma generation and wound healing. N Engl J Med 315(26):1650–1659

    Article  CAS  PubMed  Google Scholar 

  20. McMillan DC (2009) Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care 12(3):223–226

    Article  PubMed  Google Scholar 

  21. Yamashita H, Katai H (2010) Systemic inflammatory response in gastric cancer. World J Surg 34(10):2399–2400

    Article  PubMed  Google Scholar 

  22. Fernández J, Clària J, Amorós A, Aguilar F, Castro M, Casulleras M et al (2019) Effects of albumin treatment on systemic and portal hemodynamics and systemic inflammation in patients with decompensated cirrhosis. Gastroenterology 157(1):149–162

    Article  PubMed  Google Scholar 

  23. Cederholm T, Jensen GL, Correia M, Gonzalez MC, Fukushima R, Higashiguchi T et al (2019) GLIM criteria for the diagnosis of malnutrition - a consensus report from the global clinical nutrition community. J Cachexia Sarcopenia Muscle 10(1):207–217

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Kamarajah SK, Bundred J, Tan BHL (2019) Body composition assessment and sarcopenia in patients with gastric cancer: a systematic review and meta-analysis. Gastric Cancer 22(1):10–22

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Shotaro Aso, MD, MPH, PhD (Department of Real World Evidence, Graduate School of Medicine, The University of Tokyo) for his helpful assistance with the statistical analyses.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan

    Masayuki Urabe, Yasuhiro Okumura, Asami Okamoto, Shoh Yajima, Koichi Yagi, Hiroharu Yamashita & Yasuyuki Seto

  2. Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan

    Hiroharu Yamashita

Authors
  1. Masayuki Urabe
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  2. Yasuhiro Okumura
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  3. Asami Okamoto
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  4. Shoh Yajima
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  5. Koichi Yagi
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  6. Hiroharu Yamashita
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  7. Yasuyuki Seto
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Contributions

Study conception and design: M. Urabe. Acquisition of data: all authors. Analysis and interpretation of data: M. Urabe and Y. Okumura. Drafting of manuscript: all authors. Critical revision: K. Yagi, H. Yamashita, and Y. Seto.

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Correspondence to Masayuki Urabe.

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Urabe, M., Okumura, Y., Okamoto, A. et al. Preoperative NUn score serves as a robust predictor of overall and disease-specific survivals following radical surgery for gastric cancer. Langenbecks Arch Surg 409, 126 (2024). https://doi.org/10.1007/s00423-024-03317-9

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