Hou Shuangshuang, Yu Yang, Li Nanbo, Yu Wenjing, Dai Zhiyuan, Li He, Guo Lianyi, Yin Jiajun, Wu Ju
Department of Graduate School, Dalian Medical University, Dalian, Liaoning, 116000, China.
Department of General Surgery, Fuyang Normal University Second Affiliated Hospital, Fuyang, Anhui, 236000, China.
BMC Gastroenterol. 2025 Aug 1;25(1):550. doi: 10.1186/s12876-025-04173-7.
BACKGROUND: This retrospective study evaluated the predictive value of preoperative albumin–bilirubin (ALBI) grade combined with sarcopenia for the long-term prognosis of patients with advanced gastric cancer (AGC) undergoing laparoscopic radical surgery. METHODS: This study analyzed clinical and pathological data from 731 patients who underwent laparoscopic gastrectomy for AGC in 2011–2019. The training and validation datasets comprised 538 and 193 cases, respectively. Preoperative serum albumin and bilirubin levels were measured to calculate the ALBI score. Sarcopenia was evaluated using the Skeletal Muscle Index (SMI) calculated from preoperative computed tomography images. A new predictive index, s-ALBI, was then established by fitting ALBI and SMI. s-ALBI-1 was defined as low ALBI with no sarcopenia, s-ALBI-2 as low ALBI with sarcopenia or high ALBI with no sarcopenia, and s-ALBI-3 as high ALBI with sarcopenia. Kaplan-Meier survival analysis was used to compare the overall survival (OS) and recurrence-free survival (RFS) of patients in different groups. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors. The predictive ability was assessed using receiver operating characteristic curves and the area under the curve (AUC), followed by external validation. RESULTS: The 5-year OS and RFS differed significantly between s-ALBI groups (OS: s-ALBI-1 vs. s-ALBI-2 vs. s-ALBI-3: 77.1% vs. 45.0% vs. 28.4%; RFS: s-ALBI-1 vs. s-ALBI-2 vs. s-ALBI-3: 67.9% vs. 38.5% vs. 24.8%, all < 0.0001). Moreover, s-ALBI was an independent risk factor for the long-term prognosis of patients with AGC, with modest predictive performance for 5-year OS (AUC = 0.672) and RFS (AUC = 0.648). These results were further confirmed in the external validation set. CONCLUSIONS: s-ALBI demonstrated modest predictive performance for long-term prognosis in patients with AGC undergoing laparoscopic gastrectomy. Preoperative risk stratification using s-ALBI may help guide personalized treatment plans and optimize therapeutic decision-making. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12876-025-04173-7.
背景：本回顾性研究评估了术前白蛋白-胆红素（ALBI）分级联合肌肉减少症对接受腹腔镜根治性手术的进展期胃癌（AGC）患者长期预后的预测价值。 方法：本研究分析了2011年至2019年接受腹腔镜胃癌切除术的731例AGC患者的临床和病理数据。训练数据集和验证数据集分别包含538例和193例病例。测量术前血清白蛋白和胆红素水平以计算ALBI评分。使用根据术前计算机断层扫描图像计算的骨骼肌指数（SMI）评估肌肉减少症。然后通过拟合ALBI和SMI建立一个新的预测指标s-ALBI。s-ALBI-1定义为低ALBI且无肌肉减少症，s-ALBI-2定义为低ALBI且有肌肉减少症或高ALBI且无肌肉减少症，s-ALBI-3定义为高ALBI且有肌肉减少症。采用Kaplan-Meier生存分析比较不同组患者的总生存期（OS）和无复发生存期（RFS）。进行单因素和多因素Cox回归分析以确定独立危险因素。使用受试者工作特征曲线和曲线下面积（AUC）评估预测能力，随后进行外部验证。 结果：s-ALBI组之间的5年OS和RFS存在显著差异（OS：s-ALBI-1组vs. s-ALBI-2组vs. s-ALBI-3组：77.1% vs. 45.0% vs. 28.4%；RFS：s-ALBI-1组vs. s-ALBI-2组vs. s-ALBI-: 67.9% vs. 38.5% vs. 24.8%，均<0.0001）。此外，s-ALBI是AGC患者长期预后的独立危险因素，对5年OS（AUC = 0.672）和RFS（AUC = 0.648）具有中等预测性能。这些结果在外部验证集中得到进一步证实。 结论：s-ALBI对接受腹腔镜胃切除术的AGC患者的长期预后具有中等预测性能。使用s-ALBI进行术前风险分层可能有助于指导个性化治疗方案并优化治疗决策。 补充信息：在线版本包含可在10.1186/s12876-025-04173-7获取的补充材料。
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