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

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

Received 18 February 2020

Accepted for publication 6 May 2020

Published 26 May 2020 Volume 2020:12 Pages 3937—3948

DOI https://doi.org/10.2147/CMAR.S250408

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Xueqiong Zhu


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 China

Correspondence: Yan-Ru Qin
Department of Oncology, Zhengzhou University First Affiliated Hospital, No. 1 Jianshe East Road, Erqi District, Zhengzhou 450052, Henan Province, People’s Republic of China
Email yanruqin@163.com

Purpose: 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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