Basic Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2020; 26(44): 6963-6978
Published online Nov 28, 2020. doi: 10.3748/wjg.v26.i44.6963
Use of the alkaline phosphatase to prealbumin ratio as an independent predictive factor for the prognosis of gastric cancer
Yang Li, Jin-Shen Wang, Yun Guo, Tao Zhang, Le-Ping Li
Yang Li, Jin-Shen Wang, Le-Ping Li, Departments of Gastrointestinal, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
Yun Guo, Center for Reproductive Medicine, Cheeloo College of Medicine, Jinan 250012, Shandong Province, China
Tao Zhang, Department of Biostatistics, School of Public Health, Shandong University, Jinan 250012, Shandong Province, China
Author contributions: Li Y and Li LP were the guarantors and designed the study; Li Y, Wang JS and Guo Y participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Zhang T participated in the statistical analysis; Wang JS and Li LP performed the review and editing.
Supported by the Key Technology Research and Development Program of Shandong, No. 2017GSF221018 and No. 2017G006007.
Institutional review board statement: The study was reviewed and approved by the Shandong Provincial Hospital Institutional Review Board, SWYX: NO. 2020-069.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: Le-Ping Li, PhD, Professor, Surgeon, Departments of Gastrointestinal, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 324 Jingwu Road, Jinan 250021, Shandong Province, China. lepingdoctor@126.com
Received: June 13, 2020
Peer-review started: June 13, 2020
First decision: September 12, 2020
Revised: September 21, 2020
Accepted: October 13, 2020
Article in press: October 13, 2020
Published online: November 28, 2020
Abstract
BACKGROUND

Gastric cancer (GC) is characterized by a low 5-year survival rate. The prognosis is still not satisfactory although it has significantly improved due to developments in medicine. Thus, the identification of more efficient indices for the evaluation of GC prognosis is required. We propose, for the first time, that the alkaline phosphatase (ALP) to prealbumin (PA) ratio (APR) can be used as an independent prognostic factor in GC.

AIM

To evaluate the prognostic value the APR in GC.

METHODS

According to the exclusion strategy, we collected the preoperative serologic examination results and clinical information of 409 GC patients treated in Shandong Provincial Hospital from January to December, 2016. By calculating the APR, the neutrophil and lymphocyte ratio (NLR), C-reactive protein (CRP) and albumin (ALB) ratio, platelet and lymphocyte ratio, lymphocyte and monocyte ratio, and the relationship with clinical information, we verified the role of preoperative APR ratio in the prognosis of GC. In addition, we used a Cox model combined with the APR and tumor stage to demonstrate its efficacy in assessing the prognosis of GC patients.

RESULTS

Preoperative APR was an independent prognostic factor for GC. The median age of patients in the APR-high group was greater compared with that in the APR-low group. Patients with a higher APR had a more advanced clinical stage, higher neutrophil to lymphocyte, CRP to ALB, and platelet to lymphocyte ratios, but a lower lymphocyte to monocyte ratio (P < 0.05). The APR-high group also had higher glycoprotein antigen 199 and carbohydrate antigen 125 levels than the APR-low group (P < 0.05). Median overall survival and disease-free survival were significantly longer in the APR-low group than in the APR-high group. In addition, a Cox model based on the APR and tumor stage was more effective in evaluating the prognosis of patients than models based on stage alone or stage plus the NLR.

CONCLUSION

A higher APR is an independent and negative prognostic factor for GC. The prognosis of GC can be better evaluated using a Cox model based on the APR and stage.

Keywords: Gastric cancer, Prognosis, Alkaline phosphatase, Prealbumin, Evaluating efficiency

Core Tip: We are the first to propose that the alkaline phosphatase (ALP) to prealbumin (PA) ratio (APR) can be used as an independent prognostic factor in gastric cancer (GC). By comparing clinical information in different groups, we found that a high APR predicted worse prognosis. In addition, the model based on the APR and stage showed better efficiency than other models in evaluating the prognosis of GC.