Preoperative pre-albumin predicts prognosis of patients after gastrectomy for adenocarcinoma of esophagogastric junction
Han et al. World Journal of Surgical Oncology
Preoperative pre-albumin predicts prognosis of patients after gastrectomy for adenocarcinoma of esophagogastric junction
Wen-xiu Han 0
Zhang-ming Chen 0
Zhi-jian Wei
A-man Xu
0 Equal contributors Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University , Hefei, Anhui Province 230032 , China
Background: Adenocarcinoma of esophagogastric junction (AEG) was initially proposed in 1999 by Siewert. During recent decades, the incidence and prevalence of AEG were arising globally whereas the incidence of gastric cancer is gradually declining. Complete blood counting and liver function tests, as the routine examination of immune and nutritional status, were reported to be the predictors of overall survival (OS) in some tumors. However, little is known about the prognostic significance of these indexes in AEG patients. The purpose of this study was to assess the prediction of preoperative pre-albumin, hemoglobin, and prognostic nutritional index (PNI) for survival outcomes in AEG patients. Methods: A retrospective cohort of 101 AEG patients followed by radical surgery was recruited between January and July 2010. Clinical and laboratory data were obtained and used to evaluate the predictive value through survival analysis. Receiver operating characteristic (ROC) curve analysis determined 200 mg/L, 120 g/L, 5 cm, and 51 as the cutoff values of pre-albumin, hemoglobin, tumor size, and PNI, respectively. Results: Univariate analysis revealed that AEG patients with hemoglobin ≥120 g/L, albumin ≥40 g/L, prealbumin ≥200 g/L, PNI ≥51, and tumor size <5 cm had longer OS (P < 0.05). Additionally, pre-albumin, tumor size, and TNM stage were demonstrated to be independent prognostic indicators by multivariate analysis with Cox regression, and the performance of pre-albumin for predicting OS in AEG patients was further identified by ROC curves (P = 0.006). Conclusions: Preoperative pre-albumin was an independent prognostic factor, and a high level of prealbumin predicted longer OS in AEG patients.
AEG; Gastric cancer; Pre-albumin; PNI; OS
-
Background
Gastric cancer (GC) was one of the most prevalent
malignant diseases worldwide and ranked second for
cancer deaths in 2013, especially in developing
countries [1]. Adenocarcinoma of esophagogastric junction
(AEG), as one of special malignant tumors due to
their borderline location between the esophagus and
stomach, was initially proposed in 1999 by Siewert
[2]. During recent decades, the incidence and
prevalence of AEG were arising globally whereas the
incidence of gastric cancer is gradually declining [3–5].
Siewert et al. proposed that tumors at the location
within 5 cm from the Z-line were defined as AEG
independently and classified as three types, which have been
widely adopted worldwide [6]. Recent epidemiological and
clinical studies suggested that the prevalence, etiology,
pathology, treatments, and outcomes of AEG were
distinguishing obviously from tumors at other locations, even in
the three types of AEG [7].
© The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The competition between tumor aggression and body
defense is crucial for prognosis of cancer-related overall
survivals (OS). Among them, immune and nutritional
status of patients with cancer had gradually become the
focus in the field of cancer research nowadays [8],
especially in patients with postoperative chemotherapy.
Complete blood counting and liver function tests, as the
routine examinations before surgery, were reported to
be the predictors of OS in some tumors, such colorectal
cancer, breast cancer, hepatocellular carcinoma, and GC
[8–11]. Hemoglobin and albumin were the most
common parameters to reflect the nutritional status, which
of the lower level was demonstrated to be associated
with poorer prognosis for patients with GC.
Additionally, neutrophils to lymphocytes ratio (NLR) and
platelets to lymphocytes ratio (PLR), as predictors of patients
with GC, have been studied worldwide.
To our best knowledge, no studies had republished to
access the prediction of these indexes for survival
outcome in patients with AEG who underwent gastrectomy
and chemotherapy. Here, the aim of this study was to
research the clinical values of these parameters for
prediction of OS in AEG patients.
Methods
Patients
The patients, who underwent radical open total or
proximal gastrectomy fo (...truncated)