Chen Guang-Liang, Huang Yan, Zhang Wen, Pan Xu, Feng Wan-Jing, Zhao Xiao-Ying, Zhu Xiao-Dong, Li Wen-Hua, Huang Mingzhu, Chen Zhi-Yu, Guo Wei-Jian
Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China.
Front Oncol. 2021 Sep 10;11:667655. doi: 10.3389/fonc.2021.667655. eCollection 2021.
To characterize clinical features and identify baseline prognostic factors for survival in young adults with advanced gastric cancer (YAAGC).
A total of 220 young inpatients (age less than or equal to 40 years) with an initial diagnosis of advanced gastric cancer were retrospectively enrolled in this study.
Of a consecutive cohort of 220 patients with YAAGC, the median overall survival (OS) time was 16.3 months. One-year survival rate was 43.6% (95% CI: 36.5 to 50.7). In this cohort, a female (71.4%, = 157) predominance and a number of patients with poorly differentiated tumors (95.9%, = 211) were observed. In the univariate analysis, OS was significantly associated with neutrophil-lymphocyte ratio (NLR) (≥3.12), hypoproteinemia (<40 g/L), presence of peritoneal or bone metastases, and previous gastrectomy of primary tumor or radical gastrectomy. In multivariate Cox regression analysis, hypoproteinemia [hazard ratio (HR) 1.522, 95% CI 1.085 to 2.137, = 0.015] and high NLR level (HR 1.446, 95% CI 1.022 to 2.047, = 0.021) were two independent poor prognostic factors, while previous radical gastrectomy was associated with a favorable OS (HR 0.345, 95% CI 0.205 to 0.583, = 0.000). A three-tier prognostic index was constructed dividing patients into good-, intermediate-, or poor-risk groups. Median OS for good-, intermediate-, and poor-risk groups was 36.43, 17.87, and 11.27 months, respectively.
Three prognostic factors were identified, and a three-tier prognostic index was devised. The reported prognostic index may aid clinical decision-making, patient risk stratification, and planning of future clinical studies on YAAGC.
描述青年晚期胃癌（YAAGC）患者的临床特征并确定生存的基线预后因素。
本研究回顾性纳入了220例初诊为晚期胃癌的青年住院患者（年龄小于或等于40岁）。
在连续的220例YAAGC患者队列中，中位总生存期（OS）为16.3个月。1年生存率为43.6%（95%CI：36.5至50.7）。在该队列中，观察到女性占优势（71.4%，n = 157），且有许多低分化肿瘤患者（95.9%，n = 211）。单因素分析中，OS与中性粒细胞-淋巴细胞比值（NLR）（≥3.12）、低蛋白血症（<40 g/L）、腹膜或骨转移的存在以及原发性肿瘤既往胃切除术或根治性胃切除术显著相关。多因素Cox回归分析中，低蛋白血症[风险比（HR）1.522，95%CI 1.085至2.137，P = 0.015]和高NLR水平（HR 1.446，95%CI 1.022至2.047，P = 0.021）是两个独立的不良预后因素，而既往根治性胃切除术与良好的OS相关（HR 0.345，95%CI 0.205至0.583，P = 0.000）。构建了一个三级预后指数，将患者分为低、中、高风险组。低、中、高风险组的中位OS分别为36.43、17.87和11.27个月。
确定了三个预后因素，并设计了一个三级预后指数。所报道的预后指数可能有助于YAAGC的临床决策、患者风险分层以及未来临床研究的规划。
