Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2015; 21(19): 5961-5971
Published online May 21, 2015. doi: 10.3748/wjg.v21.i19.5961
Novel immunological and nutritional-based prognostic index for gastric cancer
Kai-Yu Sun, Jian-Bo Xu, Shu-Ling Chen, Yu-Jie Yuan, Hui Wu, Jian-Jun Peng, Chuang-Qi Chen, Pi Guo, Yuan-Tao Hao, Yu-Long He
Kai-Yu Sun, Jian-Bo Xu, Yu-Jie Yuan, Hui Wu, Jian-Jun Peng, Chuang-Qi Chen, Yu-Long He, Division of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
Shu-Ling Chen, Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
Pi Guo, Yuan-Tao Hao, Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
Author contributions: Sun KY, Xu JB, Chen SL contributed equally to the work; Sun KY Xu JB, Chen SL and He YL designed the research; Sun KY, Xu JB, Chen SL, Yuan YJ, Wu H and Peng JJ performed the research; Sun KY, Xu JB, Chen SL and Chen CQ analyzed the data; Guo P and Hao YT helped with the statistical analysis; Sun KY, Xu JB, Chen SL and He YL wrote the paper.
Supported by National Natural Science Foundation of China, Nos. 81101865 and 81272637; Doctoral Fund of the Ministry of Education of China, No. 20110171120064; Natural Science Foundation of Guangdong Province, No. S2013020012724; and Clinical Medicine Research Project 5010 of Sun Yat-sen University, No. 2010006.
Ethics approval: The study was reviewed and approved by the Medical Institutional Review Board of the First Affiliated Hospital of Sun Yat-sen University.
Informed consent: All study participants or their legal guardians provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors have declared no conflicts of interest.
Data sharing: Technical appendix and statistical code available from the corresponding author at ylh@medmail.com.cn.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yu-Long He, MD, PhD, Division of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Second Road, Guangzhou 510080, Guangdong Province, China. ylh@medmail.com.cn
Telephone: +86-20-28823389 Fax: +86-20-28823389
Received: October 19, 2014
Peer-review started: October 20, 2014
First decision: December 26, 2014
Revised: January 9, 2014
Accepted: January 21, 2015
Article in press: January 21, 2015
Published online: May 21, 2015
Processing time: 212 Days and 17.6 Hours
Abstract

AIM: To assess the prognostic significance of immunological and nutritional-based indices, including the prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio in gastric cancer.

METHODS: We retrospectively reviewed 632 gastric cancer patients who underwent gastrectomy between 1998 and 2008. Areas under the receiver operating characteristic curve were calculated to compare the predictive ability of the indices, together with estimating the sensitivity, specificity and agreement rate. Univariate and multivariate analyses were performed to identify risk factors for overall survival (OS). Propensity score analysis was performed to adjust variables to control for selection bias.

RESULTS: Each index could predict OS in gastric cancer patients in univariate analysis, but only PNI had independent prognostic significance in multivariate analysis before and after adjustment with propensity scoring (hazard ratio, 1.668; 95% confidence interval: 1.368-2.035). In subgroup analysis, a low PNI predicted a significantly shorter OS in patients with stage II-III disease (P = 0.019, P < 0.001), T3-T4 tumors (P < 0.001), or lymph node metastasis (P < 0.001). Canton score, a combination of PNI, NLR, and platelet, was a better indicator for OS than PNI, with the largest area under the curve for 12-, 36-, 60-mo OS and overall OS (P = 0.022, P = 0.030, P < 0.001, and P = 0.024, respectively). The maximum sensitivity, specificity, and agreement rate of Canton score for predicting prognosis were 84.6%, 34.9%, and 70.1%, respectively.

CONCLUSION: PNI is an independent prognostic factor for OS in gastric cancer. Canton score can be a novel preoperative prognostic index in gastric cancer.

Keywords: Gastric cancer; Prognostic nutritional index; Canton score; Prognosis; Neutrophil-lymphocyte ratio; Platelet-lymphocyte ratio

Core tip: This is the first study to compare the prognostic significance of different immuno-nutritional indices including prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in gastric cancer. We found that PNI was an independent prognostic factor for overall survival in gastric cancer before and after the propensity score analysis, especially in patients with advanced disease, deep tumors, or lymph node metastasis. We also proposed that a new index-Canton score (a combination of PNI, NLR and PLT) is a superior prognostic factor compared to PNI, NLR, or PLR alone, as it better represents the relative contribution of each of these indices.