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:
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.
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
Research background

Gastric cancer (GC) is a disease with a high mortality and recurrence rate, and its prognosis is still not ideal. Thus, in order to help doctors to develop and modify treatment strategies, it is important to identify new prognostic factors.

Research motivation

Alkaline phosphatase (ALP) is mainly used for the diagnosis of liver and kidney diseases but rarely for GC. Prealbumin (PA) is a nutritional indicator of the body which has been widely studied. This is the first report to propose the use of the preoperative ratio of ALP to PA, referred to as the ALP to PA ratio (APR), as an independent factor for the evaluation of the prognosis of GC.

Research objectives

To investigate the predictive effect of the APR in the prognosis of GC.

Research methods

After excluding those who did not meet the inclusion criteria, we collected the hematological examination results of 409 GC patients upon admission from January to December, 2016. We then compared the clinical characteristics and survival time of patients in order to evaluate the efficiency of the APR in GC prognosis.

Research results

Patients with a higher preoperative APR had more advanced clinical stage, a higher neutrophil and lymphocyte ratio (NLR), C-reactive protein, platelet to lymphocyte ratio, glycoprotein antigen 199, and carbohydrate antigen 125 (P < 0.05). In addition, median overall survival and disease-free survival were significantly poorer in the APR-high group than in the APR-low group. The Cox model based on the APR and stage was more effective in evaluating the prognosis of patients than models based on stage alone or stage plus NLR.

Research conclusions

Preoperative APR can be an independent factor for the prognosis of GC, with a higher APR indicating a worse prognosis.

Research perspectives

The APR can be easily acquired and calculated. Thus, by facilitating a more comprehensive judgment of patient prognosis, and combined with other tests, it can help surgeons develop and adjust treatment plans.