Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2019; 25(41): 6258-6272
Published online Nov 7, 2019. doi: 10.3748/wjg.v25.i41.6258
Blood parameters score predicts long-term outcomes in stage II-III gastric cancer patients
Jian-Xian Lin, Yi-Hui Tang, Jia-Bin Wang, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin, Ru-Hong Tu, Chang-Ming Huang, Ping Li, Chao-Hui Zheng, Jian-Wei Xie
Jian-Xian Lin, Yi-Hui Tang, Jia-Bin Wang, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin, Ru-Hong Tu, Chang-Ming Huang, Ping Li, Chao-Hui Zheng, Jian-Wei Xie, Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Jian-Xian Lin, Jia-Bin Wang, Jun Lu, Qi-Yue Chen, Long-Long Cao, Chang-Ming Huang, Ping Li, Chao-Hui Zheng, Jian-Wei Xie, Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou 350108, Fujian Province, China
Author contributions: Lin JX and Tang YH contributed equally to his work and should be considered co-first authors; Li P, Zheng CH, Xie JW, Lin JX, and Tang YH conceived of the study and analyzed the data; Wang JB, Lu J, Chen QY, Cao LL, Lin M, and Tu RH helped collect the data and design the study; Lin JX and Tang YH wrote the manuscript; Li P, Zheng CH, Xie JW, Lin JX, Wang JB, Lu J, and Chen QY helped revise the manuscript critically for important intellectual content; all authors read and approved the final manuscript.
Supported by the Scientific and Technological Innovation Joint Capital Projects of Fujian Province, No. 2016Y9031; the Minimally Invasive Medical Center of Fujian Province, No. [2017]171; the Science Foundation of Fujian Province, No. 2018J01307; and the Startup Fund for Scientific Research, Fujian Medical University, No. 2016QH024.
Institutional review board statement: This study was reviewed and approved by the Fujian Medical University Union Hospital (FMUUH) Institutional Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian-Wei Xie, MD, PhD, Doctor, Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China. xjwhw2019@163.com
Telephone: +86-591-83363366 Fax: +86-591-83363366
Received: July 11, 2019
Peer-review started: July 12, 2019
First decision: August 18, 2019
Revised: September 6, 2019
Accepted: September 11, 2019
Article in press: September 11, 2019
Published online: November 7, 2019
Abstract
BACKGROUND

Increasing numbers of laboratory blood parameters (BPM) have been reported to greatly affect the long-term outcomes of gastric cancer (GC) patients. However, the existing prognostic models do not comprehensively analyze these predictors.

AIM

To construct a new prognostic tool, based on all the prognostic BPM, to achieve more accurate prognosis prediction for GC.

METHODS

We retrospectively assessed 850 consecutive patients who underwent curative resection for stage II-III GC from January 2010 to April 2013. The patients were classified into developing (n = 567) and validation (n = 283) cohorts using computer-generated random numbers. A scoring system, namely BPM score, was then constructed using least absolute shrinkage and selection operator (LASSO) Cox regression model in the developing cohort, and validated in the validation cohort. A nomogram consisting of BPM score and tumor-lymph node-metastasis (TNM) stage was further created. The discrimination and calibration of the nomogram were evaluated via Harrell’s C-statistic and the Hosmer-Lemeshow test.

RESULTS

Using the LASSO model, we established the BPM score based on five BPM: Albumin, lymphocyte-to-monocyte ratio, neutrophil-to-lymphocyte ratio, carcinoembryonic antigen, and carbohydrate antigen 19-9. The BPM scores were divided into high- and low-BPM groups based on a cut-off value of -0.93. High-BPM patients were significantly older and had more advanced, larger tumors. In the developing cohort, significant differences were found in 5-year overall survival (OS) and 5-year disease-specific survival between the high-BPM and low-BPM patients. Similar results were found in the validation group. Multivariable analysis showed that the BPM score was an independent predictor of OS. High-BPM patients had a poorer 5-year OS for each subgroup. Furthermore, a nomogram that combined the BPM score and TNM stage had significantly better prognostic value compared with TNM stage alone.

CONCLUSION

The BPM score provides more accurate prognosis prediction in stage II-III GC patients and is an effective complement to the TNM staging system.

Keywords: Blood parameters score, Gastric cancer, Long-term survival, Nomogram, Discrimination and calibration

Core tip: The study aimed to select the optimal combination of blood parameters (BPM) and to establish a novel prognostic classifier. Using the least absolute shrinkage and selection operator model, we established the BPM score based on five BPM: Albumin, lymphocyte-to-monocyte ratio, neutrophil-to-lymphocyte ratio, carcinoembryonic antigen, and carbohydrate antigen 19-9. The BPM score provides more accurate prognosis prediction in stage II-III gastric cancer patients and is an effective complement to the tumor-lymph node-metastasis staging system.