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Prognostic Score System Using Preoperative Inflammatory, Nutritional and Tumor Markers to Predict Prognosis for Gastric Cancer: A Two-Center Cohort Study

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Abstract

Introduction

Gastric cancer (GC) is the fourth leading cause of cancer-related death worldwide. Our study aimed to investigate the prognostic value of preoperative inflammatory, nutritional and tumor markers and develop an effective prognostic score system to predict the prognosis of GC patients.

Methods

We retrospectively analyzed 1587 consecutive GC patients who received curative gastrectomy from two medical centers. A novel prognostic score system was proposed based on independently preoperative markers associated with overall survival (OS) of GC patients. A nomogram based on prognostic score system was further established and validated internally and externally.

Results

Based on multivariate analysis in the training set, a novel BLC (body mass index-lymphocyte-carbohydrate antigen 19-9) score system was proposed, which showed an effective predictability of OS in GC patients (log-rank P < 0.001). Moreover, receiver-operating characteristic (ROC) analysis showed that BLC had better performance in predicting OS than the traditional prognostic markers. The C-index of the BLC based-nomogram was 0.710 (95% CI 0.686–0.734), and the areas under ROC curves for predicting 3- and 5-year OS were 0.781 (95% CI 0.750–0.813) and 0.755 (95% CI 0.723–0.786), respectively, which were higher than those of tumor node metastasis (TNM) staging system alone. The calibration curve for probability of 3- and 5-year OS rate showed a good fitting effect between prediction by nomogram and actual observation. Verification in the internal and external validation sets showed results consistent with those in the training set.

Conclusions

The BLC combining inflammatory, nutritional and tumor markers was an independent prognostic predictor for GC patients, and the nomogram based on BLC could accurately predict the personalized survival of patients with GC.

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Acknowledgements

Funding

This study was funded by (1) Foundation of Science & Technology Department of Sichuan Province (20YYJC3357); (2) National Natural Science Foundation of China, No. 82072688; (3) Post-Doctor Research Project, West China Hospital, Sichuan University (2018HXBH010); (4) Project funded by China Postdoctoral Science Foundation (2019M653418, 2020T130449). The Rapid Service Fee was funded by the authors.

Authorship

Huayang Pang, Weihan Zhang, Xianwen Liang, Ziqi Zhang, Xiaolong Chen, Linyong Zhao, Kai Liu, Danil Galiullin, Kun Yang, Xinzu Chen and Jiankun Hu meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Authorship contribution

Conceptualization: Huayang Pang, Weihan Zhang; Methodology: Huayang Pang, Weihan Zhang, Xianwen Liang, Xiaolong Chen, Linyong Zhao, Kai Liu, Kun Yang, Xinzu Chen; Formal analysis and investigation: Huayang Pang, Weihan Zhang, Ziqi Zhang; Writing - original draft preparation: Huayang Pang, Weihan Zhang; Writing - Review & Editing: Xianwen Liang, Danil Galiullin; Funding acquisition: Weihan Zhang, Jiankun Hu; Supervision: Jiankun Hu.

Disclosures

Huayang Pang, Weihan Zhang, Xianwen Liang, Ziqi Zhang, Xiaolong Chen, Linyong Zhao, Kai Liu, Danil Galiullin, Kun Yang, Xinzu Chen and Jiankun Hu declare no potential conflicts of interest.

Compliance with Ethics Guidelines

Patient records from two medical centers were anonymized and de-identified prior to analysis, and signed patient informed consent was obtained before operation. This retrospective study was approved by the Research Ethics Committee of West China Hospital, which is the principal affiliation of this study. The ethical approval number was no. WCH SGCPR-2021–04. The study was conducted in accordance with the Helsinki Declaration of 1964 and its later amendments.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author notes

  1. Huayang Pang, Weihan Zhang, Xianwen Liang are Co-first authors.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, No 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan, China

    Huayang Pang, Weihan Zhang, Xianwen Liang, Ziqi Zhang, Xiaolong Chen, Linyong Zhao, Kai Liu, Danil Galiullin, Kun Yang, Xinzu Chen & Jiankun Hu

  2. Department of Gastrointestinal Surgery, Hai Kou Hospital, Central South University, Hai Kou, China

    Xianwen Liang

  3. Central Research Laboratory, Bashkir State Medical University, Ufa, Russia

    Danil Galiullin

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  1. Huayang Pang
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Corresponding author

Correspondence to Jiankun Hu.

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Pang, H., Zhang, W., Liang, X. et al. Prognostic Score System Using Preoperative Inflammatory, Nutritional and Tumor Markers to Predict Prognosis for Gastric Cancer: A Two-Center Cohort Study. Adv Ther 38, 4917–4934 (2021). https://doi.org/10.1007/s12325-021-01870-z

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