Liu Bin Zheng, Tao Lin, Chen Yun Zhao, Li Xu Zhe, Dong Yu Ling, Ma Ya Jing, Li Shu Gang, Li Feng, Zhang Wen Jie
Department of Pathology, the First Affiliated University Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, China.
The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Shihezi University School of Medicine, Shihezi, Xinjiang, China.
PLoS One. 2016 Jun 16;11(6):e0157401. doi: 10.1371/journal.pone.0157401. eCollection 2016.
Gastric cancer (GC) is common and its prognosis is often poor due to difficulties in early diagnosis and optimal treatment strategies. TNM staging system is useful in predicting prognosis but only possible after surgery. Therefore, it is desirable to investigate prognostic factors/markers that may predict prognosis before surgery by which helps appropriate management decisions preoperatively.
A total of 320 GC patients were consecutively recruited from 2004 to 2013 and followed up for 127 months (10.6 years) after surgery. These patients' were examined for body mass index (BMI) and blood levels of albumin, triglyceride, total cholesterol, low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C). Kaplan-Meier method and log rank test were used to analyze long-term survival using the above potential risk markers. We first employed medians of these variables to reveal maximal potentials of the above prognostic predictors.
Three major findings were obtained: (1) Preoperative BMI was positively correlated with albumin (r = 0.144, P<0.05) and triglyceride (r = 0.365, P<0.01), but negatively correlated with TNM staging (r = -0.265, P<0.05). Preoperative albumin levels were positively correlated with triglyceride (r = 0.173, P<0.05) but again, negatively correlated with TNM staging (r = -0.137, P<0.05); (2) Poor survival was observed in GC patients with lower levels of BMI (P = 0.028), albumin (P = 0.004), and triglyceride (P = 0.043), respectively. Receiver operating characteristic (ROC) curve analyses suggested BMI, albumin and triglyceride to have survival-predictor powers similar to TNM system; and (3) Cox multi-factorial analyses demonstrated that age (P = 0.049), BMI (P = 0.016), cell differentiation (P = 0.001), and TNM staging (P = 0.011) were independent overall survival-predictors for GC patients.
Preoperative BMI, albumin, and triglyceride levels are capable of predicting survival for GC patients superior to postoperative TNM system in terms of timing for management. As potential survival-predictors, preoperative tests of BMI, albumin and triglyceride, combined with clinical imaging, may help personalized management for GC patients including planning surgical strategy, optimal radio-chemotherapy and appropriate follow-up intervals after surgery.
胃癌（GC）较为常见，由于早期诊断困难和缺乏最佳治疗策略，其预后往往较差。TNM分期系统有助于预测预后，但仅在手术后才有可能。因此，有必要研究可能在手术前预测预后的预后因素/标志物，这有助于术前做出适当的管理决策。
2004年至2013年连续招募了320例GC患者，并在术后进行了127个月（10.6年）的随访。对这些患者进行了体重指数（BMI）以及白蛋白、甘油三酯、总胆固醇、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）的血液水平检测。采用Kaplan-Meier法和对数秩检验，使用上述潜在风险标志物分析长期生存情况。我们首先采用这些变量的中位数来揭示上述预后预测指标的最大潜力。
获得了三项主要发现：（1）术前BMI与白蛋白呈正相关（r = 0.144，P<0.05）和甘油三酯呈正相关（r = 0.365，P<0.01），但与TNM分期呈负相关（r = -0.265，P<0.05）。术前白蛋白水平与甘油三酯呈正相关（r = 0.173，P<0.05），但同样与TNM分期呈负相关（r = -0.137，P<0.05）；（2）BMI、白蛋白和甘油三酯水平较低的GC患者生存率较差（P分别为0.028、0.004和0.043）。受试者工作特征（ROC）曲线分析表明，BMI、白蛋白和甘油三酯具有与TNM系统相似的生存预测能力；（3）Cox多因素分析表明，年龄（P = 0.049）、BMI（P = 0.016）、细胞分化（P = 0.001）和TNM分期（P = 0.011）是GC患者总体生存的独立预测因素。
术前BMI、白蛋白和甘油三酯水平能够在管理时机方面比术后TNM系统更好地预测GC患者的生存情况。作为潜在的生存预测指标，术前检测BMI、白蛋白和甘油三酯，并结合临床影像学检查，可能有助于对GC患者进行个性化管理，包括规划手术策略、优化放化疗以及确定术后合适的随访间隔。
