Evaluation and validation of the prognostic value of nutrition and immunity parameters in gastric cancer after R0 resection

Abstract

Precise predictive tools are critical for choosing the individualized treatment protocols and follow-up procedures for patients with gastric cancer (GC). In this study, we aimed to evaluate and validate the prognostic abilities of preoperative nutrition and immunity parameters in GC after curative R0 resection. We established two nomograms based on 437 patients who underwent curative radical gastrectomy for gastric cancer to predict the postoperative overall survival (OS) and recurrence-free survival (RFS), and then compared the predictive accuracy and discriminative ability of the nomograms with the TNM stage systems for GC. An internal validation cohort of 141 patients and an external validation cohort of 116 patients were used to validate the result. The independent predictive factors for OS or RFS, including T stage, N stage, differentiated degree, neutrophil monocyte lymphocyte ratio (NMLR) and albumin globulin ratio (AGR) were used to establish the 2 nomograms. The C-index of the OS nomogram was 0.802, which was higher than that of the AGR, the NMLR and the TNM stage. The C-index of the RFS nomogram was 0.850, which was higher than that of the AGR, the NMLR and the TNM stage. Analogously, the areas under the receiver operating characteristics curves (AUROCs, 0.920 for OS and 0.897 for RFS, respectively) of the two nomograms were higher than that of the NMLR, the AGR and the TNM stage. In the internal validation cohort, the C-indexes of the OS and RFS nomograms were 0.812 and 0.826, respectively. In the external validation cohort, the C-indexes of the OS and RFS nomograms were 0.866 and 0.880, respectively. The proposed nomograms including nutrition and immunity parameters were proved to have excellent predictive ability in survival and recurrence for patients with GC after R0 resection.

Low Pretreatment Albumin-to-Globulin Ratio Predicts Poor Prognosis in Gastric Cancer: Insight From a Meta-Analysis

“…The cut-off value for AGR ranged from 1.14 to 1.93. All studies reported the association between AGR and OS, and four ( 11 , 13 , 14 , 19 ) reported the association between AGR and DFS or AGR and PFS. Ten of studies were published in English, two ( 12 , 16 ) in Chinese.…”

Geriatric nutritional risk index as a prognostic marker of pTNM-stage I and II esophageal squamous cell carcinoma after curative resection

“…Many studies have identified that the tumor-or nutrition-associated factors and host immunity strongly affect the prognoses in patients with cancer [13][14][15]. Thus, Figure 1).…”

Development and validation of a nomogram to predict the prognosis of patients with gastric cardia cancer

“…The DCA results show that the nomogram we developed has good clinical practical value. Recently, some nomograms containing various input variables have been developed to predict the prognosis of different digestive tract tumors [19][20][21][22] . Kim et al 19 developed and validated a nomogram that predicted the risk of lymph node metastasis in patients with early gastric cancer and could be used to avoid unnecessary gastrectomy after endoscopic dissection.…”

“…By analyzing 9,026 patients with metastatic esophageal cancer between 2010 and 2015, Zhu et al 20 found that the nomogram was better at predicting distant metastasis of esophageal cancer than traditional TNM staging. Similarly, the nomogram developed by Xue et al 21 that includes nutritional and immune parameters can effectively predict the overall and postoperative survival rate and relapse-free survival of gastric cancer patients after radical gastrectomy, and its prediction accuracy and discrimination ability are better than those of TNM staging.…”