Objective: The aim of this study was to investigate the prognostic value of preoperative sarcopenia and systemic inflammation for patients with resectable gastric cancer (GC) and develop a novel and powerful prognostic score based on these factors.
Materials and methods: Patients with GC who underwent radical gastrectomy between December 2009 and December 2013 were included. A multivariate Cox regression analysis was performed to identify the prognostic factors. A novel prognostic score (SLMR) was developed based on preoperative sarcopenia and the lymphocyte-monocyte ratio (LMR), and its prognostic value was evaluated.
Results: In total, 1,167 patients with resectable GC were included in the study. On multivariate analysis, preoperative sarcopenia and the LMR were shown to be independent prognostic factors (both p < .001). A low LMR was an independent predictor from sarcopenia (p < .001). Based on preoperative sarcopenia and the LMR, we established the SLMR. An elevated SLMR was associated with older age, higher ASA scores, larger tumor size, advanced stages, and vascular invasion (all p < .05). Multivariate analysis revealed that the SLMR was a significant independent predictor (p < .001). We incorporated the SLMR into a prognostic model that included tumor size and TNM stage and generated a nomogram, which accurately predicted 3- and 5-year survival for GC patients.
Conclusion: Preoperative systemic inflammation is significantly associated with sarcopenia. The LMR combined with sarcopenia could enhance prognostication for patients with GC who underwent radical gastrectomy.
Implications for practice: Increasing evidence shows that sarcopenia and systemic inflammation are closely associated with the prognosis of malignant tumors, and it is essential for clinicians to understand the relationship and combined prognostic effects of these factors for gastric cancer (GC). Based on a large data set, this study found that preoperative systemic inflammation was significantly associated with sarcopenia in GC, and combining these two predictors could effectively predict the prognosis and complement the prognostic value of the TNM staging system. These findings may lead to the development of new therapeutic avenues to improve cancer outcomes.
摘要
目标。本研究的目的在于调查可切除性胃癌 (GC) 患者出现术前肌肉减少症和全身炎症的预后价值，并根据这些因素建立新的有效预后评分。
材料和方法。我们招募了 2009 年 12 月至 2013 年 12 月接受胃癌根治术的GC患者。采用多变量 Cox 回归分析确定了预后因素。我们根据术前肌肉减少症和淋巴细胞与单核细胞比率 (LMR) 建立了新的预后评分 (SLMR)，并评估了其预后价值。
结果。本研究共招募了 1 167 名可切除性GC患者。多变量分析显示，术前肌肉减少症和LMR属于独立预后因素(两者的 p < 0.001)。LMR低是肌肉减少症的独立预测因子 (p < 0.001)。根据术前肌肉减少症和LMR，我们确立了SLMR。SLMR升高与年龄较大、ASA 评分较高、肿瘤尺寸较大、晚期胃癌和血管浸润(所有的 p < 0.05)有关。多变量分析表明，SLMR是重要的独立预测因子 (p < 0.001)。我们将SLMR纳入包括肿瘤尺寸和 TNM 分期的预后模型中，并生成了列线图，准确预测胃癌患者的 3 年和 5 年生存率。
结论。术前全身炎症与肌肉减少症显著相关。LMR结合肌肉减少症可加强对接受过胃癌根治术的GC患者的预后。
实践意义:越来越多的证据表明，肌肉减少症和全身炎症与恶性肿瘤的预后密切相关，临床医生必须了解这些因素与胃癌 (GC) 的关系及综合预后效果。基于大量的数据集，本研究发现，术前全身炎症与GC肌肉减少症显著相关，将这两种预测因子相结合，可有效预测预后并补强 TNM 分期系统的预后价值。上述结果让我们可以开发新的治疗途径，进而改善癌症预后。
Keywords: Gastric cancer; Prognosis; Sarcopenia; Systemic inflammation.
© AlphaMed Press 2019.