Published online Nov 28, 2020. doi: 10.3748/wjg.v26.i44.6963
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
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.
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.
To investigate the predictive effect of the APR in the prognosis of GC.
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.
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.
Preoperative APR can be an independent factor for the prognosis of GC, with a higher APR indicating a worse prognosis.
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.