Wang Nan, Xi Wenqi, Lu Sheng, Jiang Jinling, Wang Chao, Zhu Zhenglun, Yan Chao, Liu Jing, Zhang Jun
Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Oncol. 2021 Jun 14;11:650562. doi: 10.3389/fonc.2021.650562. eCollection 2021.
The present study was designed to explore the prognostic value of preoperative inflammatory and nutritional biomarkers in stage III gastric cancer (GC) patients with adjuvant chemotherapy and to develop a novel scoring system called the inflammatory-nutritional prognostic score (INPS).
A total of 513 patients with pathological stage III GC undergoing radical gastrectomy followed by adjuvant chemotherapy from 2010 to 2017 were enrolled in the study. Clinicopathological characteristics and blood test parameters of individual patients were collected. The least absolute shrinkage and selection operator (LASSO) Cox regression model was used for feature selection to construct INPS. Survival curves were generated using the Kaplan-Meier method with log-rank tests. The nomogram was generated based on the result of the multivariate analysis using Cox's proportional hazards model. The model was assessed by the concordance index (C-index) and was internally validated by bootstraps.
According to the results of Lasso Cox regression and K-M survival curves, INPS was determined as follows: a low body mass index (BMI) (<23 kg/m), a low prealbumin (<180 mg/L), a high neutrophil-lymphocyte ratio (NLR) (≥2.7), a high platelet-lymphocyte ratio (PLR) (≥209.4), a low lymphocyte-monocyte ratio (LMR) (<2.8), and a low prognostic nutritional index (PNI) (<45.1); each were scored as 1, and the remaining values were scored as 0. The individual scores were then summed up to construct the INPS and further divided into 4 groups: Low Risk (INPS 0); Low-medium Risk (INPS 1); High-medium Risk (INPS 2-4); and High Risk (INPS 5-6). In multivariate analysis, INPS was an independent predictor of overall survival (OS) in stage III GC, with the 5-year OS rates of 70.8%, 57.4%, 41.5%, and 30.6%, respectively. The nomogram based on INPS and other independent predictors (gender, pT stage, pN stage, lymphovascular invasion, and CEA level) showed good predicting performance with a C-index of 0.707, which was superior to the TNM stage alone (C-index 0.645, =0.008) and was internally validated with the corrected C-index of 0.693.
Preoperative INPS was an independent prognostic factor of stage III GC patients with radical surgery followed by adjuvant chemotherapy. The nomogram based on INPS may serve as a simple and potential model in risk stratification and guiding treatment strategies in clinical practice.
本研究旨在探讨术前炎症和营养生物标志物在接受辅助化疗的Ⅲ期胃癌（GC）患者中的预后价值，并开发一种名为炎症-营养预后评分（INPS）的新型评分系统。
本研究纳入了2010年至2017年间共513例接受根治性胃切除术后辅助化疗的病理Ⅲ期GC患者。收集了个体患者的临床病理特征和血液检测参数。采用最小绝对收缩和选择算子（LASSO）Cox回归模型进行特征选择以构建INPS。使用Kaplan-Meier方法和对数秩检验生成生存曲线。基于Cox比例风险模型的多变量分析结果生成列线图。通过一致性指数（C指数）评估模型，并通过自举法进行内部验证。
根据Lasso Cox回归和K-M生存曲线的结果，INPS定义如下：低体重指数（BMI）（<23kg/m²）、低前白蛋白（<180mg/L）、高中性粒细胞与淋巴细胞比值（NLR）（≥2.7）、高血小板与淋巴细胞比值（PLR）（≥209.4）、低淋巴细胞与单核细胞比值（LMR）（<2.8）和低预后营养指数（PNI）（<45.1）；每项评分为1分，其余值评分为0分。然后将各个分数相加构建INPS，并进一步分为4组：低风险（INPS 0）；低-中风险（INPS 1）；高-中风险（INPS 2-4）；和高风险（INPS 5-6）。在多变量分析中，INPS是Ⅲ期GC患者总生存（OS）的独立预测因子，5年OS率分别为70.8%、57.4%、41.5%和30.6%。基于INPS和其他独立预测因子（性别、pT分期、pN分期、淋巴管侵犯和CEA水平）的列线图显示出良好的预测性能，C指数为0.707，优于单独的TNM分期（C指数0.645，P=0.008），并通过校正后的C指数0.693进行了内部验证。
术前INPS是接受根治性手术并辅助化疗的Ⅲ期GC患者的独立预后因素。基于INPS的列线图可作为临床实践中风险分层和指导治疗策略的简单且有潜力的模型。
