Department of Hepatobiliary and Intestinal Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, 283 Tongzipo Road, Changsha, 410013, Hunan, China.
Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China.
Gastric Cancer. 2023 Nov;26(6):1051-1062. doi: 10.1007/s10120-023-01422-0. Epub 2023 Aug 14.
The aim of this study was to investigate the predictive value of procalcitonin (PCT) on post-operative day (POD) 3 and 5 for the prognosis of gastric adenocarcinoma (GA) patients who underwent radical gastrectomy surgery in extended cohort from a prospective bi-center study.
Consecutive GA patients who received surgery in the Hunan Cancer Hospital were enrolled as the training cohort, and those from Wuhan Union Hospital were included as external validation cohort. The optimal cutoff concentration of PCT for overall survival (OS) in the training cohort was determined by X-tile. The independent predictive factors for OS were identified using univariate and multivariate Cox regression analyses. Furthermore, the predictive value of elevated PCT was clarified in the validation cohort and propensity score matched cohort, respectively.
The optimal cutoff concentrations of PCT for OS were 0.67 ng/mL at POD 3 and 0.39 ng/mL at POD 5 in the training cohort (n = 906). Patients with higher PCT concentrations (≥ 0.39 ng/mL) at POD 5 had a significantly worse prognosis whether developing post-operative infections or not. Moreover, a synergistic influence was confirmed in those with elevated PCT concentration and infections. Multivariate analyses confirmed that PCT concentration ≥ 0.39 ng/mL at POD 5 was significantly associated with poorer survival in training cohort (HR: 1.422, 95% CI 1.041-1.943, P = 0.027), validation cohort (n = 297, HR: 2.136, 95% CI 1.073-4.252, P = 0.031) and matched cohort (n = 901, HR: 1.454, 95% CI 1.104-1.914, P = 0.008), separately.
PCT concentration ≥ 0.39 ng/mL at POD 5 was a reliable predictor for poorer prognosis in GA patients undergoing radical gastrectomy.
本研究旨在探讨术后第 3 天和第 5 天降钙素原 (PCT) 对接受根治性胃切除术的胃腺癌 (GA) 患者预后的预测价值，研究对象来自于一项前瞻性双中心研究的扩展队列。
连续纳入在湖南省肿瘤医院接受手术的 GA 患者作为训练队列，在武汉协和医院接受手术的患者作为外部验证队列。通过 X-tile 确定训练队列中总生存 (OS) 的 PCT 最佳截断浓度。采用单因素和多因素 Cox 回归分析确定 OS 的独立预测因素。此外，分别在验证队列和倾向评分匹配队列中阐明了升高的 PCT 的预测价值。
训练队列 (n=906) 中，POD3 时 PCT 的 OS 最佳截断浓度为 0.67ng/mL，POD5 时为 0.39ng/mL。POD5 时 PCT 浓度较高（≥0.39ng/mL）的患者无论是否发生术后感染，预后均较差。此外，在 PCT 浓度升高且合并感染的患者中，证实存在协同影响。多因素分析证实，POD5 时 PCT 浓度≥0.39ng/mL 与训练队列中的生存较差显著相关（HR：1.422，95%CI 1.041-1.943，P=0.027）、验证队列（n=297，HR：2.136，95%CI 1.073-4.252，P=0.031）和匹配队列（n=901，HR：1.454，95%CI 1.104-1.914，P=0.008）。
POD5 时 PCT 浓度≥0.39ng/mL 是接受根治性胃切除术的 GA 患者预后不良的可靠预测指标。
