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Albumin concentrations plus neutrophil lymphocyte ratios for predicting overall survival after curative resection for gastric cancer

Authors Sun X, Wang J, Liu J, Chen S, Liu X

Received 16 March 2016

Accepted for publication 1 June 2016

Published 27 July 2016 Volume 2016:9 Pages 4661—4669


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Ram Prasad

Peer reviewer comments 5

Editor who approved publication: Dr William Cho

Xiaowei Sun,1,2,* Juncheng Wang,1,3,* Jianjun Liu,1,2 Shangxiang Chen,1,2 Xuechao Liu1,2

1State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 2Department of Gastric and Pancreatic Surgery, 3Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China

*These authors contributed equally to this work

Background: In patients with gastric cancer (GC), survival is poor, given the late diagnosis. Risk-stratifying these patients earlier could help improve care. We determined whether combining preoperative albumin concentration and the neutrophil lymphocyte ratio (COA-NLR) could predict overall survival (OS) better than other prognostic indexes.
Methods: We calculated the COA-NLR and other prognostic indexes with data obtained within 1 week before surgery in a retrospective analysis of patients with GC undergoing curative resection between September 2000 and November 2012. Patients with concentrations of hypoalbuminemia above 35 g/L and an NLR value of 2.3 or higher were given a score of 2. Patients with one of these conditions or neither were allocated scores of 1 or 0, respectively. Patients were monitored until July 2014.
Results: OS in the 873 eligible patients was 44.9% in patients with a COA-NLR score of 0, 29.8% in patients with a score of 1, and 20.3% in patients with a score of 2 (P<0.001). The COA-NLR score was independently associated with OS (hazard ratio, 1.35; 95% confidence interval, 1.12 to 1.63; P=0.002). Moreover, the area under the receiver operating characteristics curve was 0.62 for the COA-NLR, which was significantly higher (<0.001) than that of the NLR ratio (0.60), the Glasgow prognostic score (0.58), and the platelet lymphocyte ratio (0.54). The COA-NLR was especially accurate for patients with stage I–II GC and the three values (0, 1, and 2) divided patients into subgroups more accurately than did the other indexes (area under the curve value: 0.66, P<0.001).
Conclusion: The preoperative COA-NLR index is useful for predicting postoperative OS in patients with GC and can be used to guide targeted therapy.

Keywords: albumin concentration, neutrophil-to-lymphocyte ratio, gastric cancer, prognosis, adjuvant chemotherapy

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