The prealbumin-CD19 index predicts surgical survival in patients with GC.

OBJECTIVE

This study aimed to establish a prealbumin (PALB)-CD19 index that combines nutritional and immune statuses to comprehensively evaluate the prognosis of GC patients undergoing surgery.

METHODS

A total of 389 patients who were diagnosed with GC and who underwent surgical procedures at our institution between January 2016 and December 2020 were included in this study. Among them, 97 patients underwent subtotal gastrectomy, 271 underwent total gastrectomy, and 21 underwent palliative resection. The PALB-CD19 index was developed using Cox regression analysis and regression coefficients, and LASSO regression analysis was employed to eliminate multicollinearity. Receiver operating characteristic (ROC) curves were used to calculate optimal cut-off values, and the prognostic value of different indices was compared using the area under the curve (AUC). Cox regression analysis was further utilized to identify independent prognostic factors. Survival analysis was conducted to explore differences in progression-free survival (PFS) and overall survival (OS) among patient groups. Finally, the prognostic significance of relevant factors was validated using a nomogram.

RESULTS

This study included 389 patients, 276 males and 113 females, with a mean age of 59.10 ± 10.19 years. Cox analysis identified PALB and CD19 as significant factors influencing survival, forming the basis for the PALB-CD19 index. The cut-off values for PALB and CD19 were determined to be 230.50 mg/L and 15.40%, respectively. Cox regression analysis confirmed that the PALB-CD19 index was an independent prognostic factor for both PFS and OS. Survival analysis demonstrated that patients with a lower PALB-CD19 index had significantly shorter PFS and OS (χ² = 45.54, P < 0.001; χ² = 47.69, P < 0.001). Subgroup analysis across different TNM stages further validated the prognostic value of the PALB-CD19 index (all P < 0.05). Nomograms incorporating the PALB-CD19 index showed high accuracy, with concordance indices (C-index) in the training and validation cohorts approaching or exceeding 0.8.

CONCLUSIONS

The PALB-CD19 index exhibits potential prognostic value in predicting surgical outcomes in GC patients. Its ability to integrate nutritional and immune parameters may provide clinicians with a novel and comprehensive tool for identifying high-risk patients and guiding personalized treatment strategies.