Guner Ali, Cho Minah, Kim Yoo-Min, Cheong Jae-Ho, Hyung Woo Jin, Kim Hyoung-Il
Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Faculty of Medicine, Department of General Surgery, Karadeniz Technical University, Trabzon, Turkey.
Front Oncol. 2021 Mar 23;11:633924. doi: 10.3389/fonc.2021.633924. eCollection 2021.
The prognostic value of postoperative parameters reflecting the inflammatory and nutritional status of patients undergoing cancer surgery has been rarely studied. This study investigated the prognostic value of inflammatory and nutritional parameters measured preoperatively and 1 month after curative gastrectomy for gastric cancer.
Data from a prospectively maintained database of 1,194 patients with gastric cancer who underwent curative surgery in 2009-2018 were retrospectively reviewed. Demographics, clinicopathologic characteristics, operative data, survival data, and laboratory parameters were extracted. Neutrophil counts, lymphocyte counts, and albumin levels before surgery and 1 month postoperatively were analyzed.
In multivariable analysis adjusted for age, sex, and pathologic stage, high neutrophil count (hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.01-1.17, p = 0.022) and low albumin (HR 0.45, 95% CI 0.27-0.74, p = 0.002) 1 month postoperatively were independent prognostic factors for overall survival. High neutrophil count (HR 1.09, 95% CI 1.02-1.16, p = 0.015) 1 month postoperatively was also an independent prognostic factor for recurrence-free survival after adjusting for age, sex, body mass index, extent of gastrectomy, and pathologic stage. Patients were classified into risk groups based on thresholds of 4.2 × 10 cells/mm and 4.1 g/dl for 1-month neutrophil count and albumin. High-risk groups had a significantly worse prognosis than low-risk groups for overall survival (HR 5.87, 95% CI 3.28-10.51, p <0.001) and recurrence-free survival (HR 1.52, 95% CI 1.07-2.16, p = 0.021).
Neutrophil count and albumin level 1 month after curative surgery reflect long-term prognosis better than preoperative values. These parameters can be used to stratify patients with the same stage into different prognostic groups.
反映癌症手术患者炎症和营养状况的术后参数的预后价值鲜有研究。本研究调查了胃癌根治性胃切除术前及术后1个月所测炎症和营养参数的预后价值。
回顾性分析2009年至2018年期间接受根治性手术的1194例胃癌患者前瞻性维护数据库中的数据。提取人口统计学、临床病理特征、手术数据、生存数据和实验室参数。分析术前及术后1个月的中性粒细胞计数、淋巴细胞计数和白蛋白水平。
在根据年龄、性别和病理分期进行调整的多变量分析中，术后1个月中性粒细胞计数高（风险比[HR]1.09，95%置信区间[CI]1.01-1.17，p = 0.022）和白蛋白水平低（HR 0.45，95%CI 0.27-0.74，p = 0.002）是总生存的独立预后因素。在根据年龄、性别、体重指数、胃切除范围和病理分期进行调整后，术后1个月中性粒细胞计数高（HR 1.09，95%CI 1.02-1.16，p = 0.015）也是无复发生存的独立预后因素。根据术后1个月中性粒细胞计数和白蛋白的阈值4.2×10⁹细胞/mm³和4.1 g/dl将患者分为风险组。高风险组的总生存（HR 5.87，95%CI 3.28-10.51，p <0.001）和无复发生存（HR 1.52，95%CI 1.07-2.16，p = 0.021）预后明显比低风险组差。
根治性手术后1个月的中性粒细胞计数和白蛋白水平比术前值更能反映长期预后。这些参数可用于将同阶段患者分层为不同的预后组。
