Preoperative lymphocyte-to-monocyte ratio is the most predictive inflammatory response marker of survival in gastric cancer

Basal metabolic rate by FAO/WHO/UNU as a prognostic factor for survival in patients with gastric cancer: A cohort study

The basal metabolic rate (BMR) is a crucial indicator of the body's energy expenditure at rest and is essential for understanding metabolic needs. This retrospective study evaluated the prognostic significance of BMR in 521 predominantly Asian patients with stage I-III gastric cancer who underwent curative-intent resection. BMR was calculated using the Food and Agriculture Organization/World Health Organization/United Nations University (FWU BMR) equation. Multivariate Cox regression analysis identified FWU BMR as a significant predictor of overall survival (OS) (P < .001). Fractional polynomial modeling revealed a linear relationship between FWU BMR and OS, with higher values correlating with lower mortality risk. The FWU model, which included FWU BMR along with other clinical variables, showed superior predictive performance (C-index: 0.815, iAUC: 0.775) compared to that of the same model lacking BMR. Additionally, although the differences were not statistically significant, the FWU model also outperformed those using the BMR derived from alternative equations, including the Harris-Benedict equation. The nomogram, based on the FWU model, demonstrated good calibration. These findings suggest that the FWU BMR is a valuable prognostic factor in patients with gastric cancer post-resection, enhancing predictive accuracy and aiding in personalized post-surgical care. However, further validation in diverse populations is required.

Monocyte Count as a Predictor of Major Adverse Limb Events in Aortoiliac Revascularization

Background/Objectives: Atherosclerosis is a leading cause of death, especially in the developed world, and is marked by chronic arterial inflammation and lipid accumulation. As key players in its progression, monocytes contribute to plaque formation, inflammation, and tissue repair. Understanding monocyte involvement is crucial for developing better therapeutic approaches. The objective of this study is to assess the prognostic value of monocytes for limb-related outcomes following revascularization for complex aortoiliac lesions, thereby emphasizing the central role of monocytes in atherosclerosis. Methods: This prospective cohort study-enrolled patients who had undergone elective aortoiliac revascularization at two hospitals between January 2013 and December 2023. Patients with TASC II type D lesions were included, excluding those with aneurysmal disease. Demographic, clinical, and procedural data were gathered, and patients were monitored for limb-related outcomes. Preoperative complete blood counts were analyzed, and statistical analyses, including multivariable Cox regression, were conducted to identify predictors of major adverse limb events (MALE). Results: The study included 135 patients with a mean age of 62.4 ± 9.20 years and predominantly male (93%). Patients were followed for a median of 61 IQR [55.4-66.6] months. Smoking history (91%) was the most prevalent cardiovascular risk factor. Preoperative monocyte count >0.720 × 109/L was associated with worse 30-day limb-related outcomes (MALE: OR 7.138 95% CI: 1.509-33.764, p = 0.013) and long-term outcomes, including secondary patency (p = 0.03), major amputation (p = 0.04), and MALE (p = 0.039). Cox regression analysis confirmed an elevated monocyte count as an independent predictor of MALE (adjusted hazard ratio 2.149, 95% CI: 1.115-4.144, p = 0.022). Conclusions: This study demonstrated that patients with a higher absolute monocyte count may be more exposed to the risk of MALE in patients with aortoiliac TASC II type D lesions undergoing revascularization, with predictive accuracy in both the short and long term. Additionally, it was an independent predictor of major amputation. This new marker has the potential to serve as a cost-effective and easily available tool for risk stratification, helping identify patients at higher risk of MALE.

Predictive significance of inflammatory markers in the survival of older Indian patients with cancer: a single-center prospective analysis

Aim

To evaluate the prognostic impact of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) on overall survival (OS) among Indian older patients with cancer.

Methods

This observational study was conducted in the geriatric oncology clinic of Tata Memorial Hospital (India). We included all patients who underwent a geriatric assessment (GA) and had a complete blood count available for analysis. The NLR was dichotomized at 3.5, PLR and LMR at the median. Our primary study outcome was OS.

Results

Between June 2018 and November 2021, 786 patients were enrolled (median age: 69 years). The most common primary tumour was lung (308, 39.5%), followed by gastrointestinal (261, 33.5%). Metastatic disease was present in 54.3% of patients. Univariate analysis revealed that patients with NLR >3.5 had shorter OS (9.1 months) than NLR <3.5 (15.7 months) (HR: 1.56). Similarly, patients with PLR >183.5 had reduced OS (9.3 months) compared to PLR <183.5 (16.6 months) (HR: 1.56). Conversely, patients with LMR >3.1 showed better OS (14.2) compared to LMR <3.1 (9.8 months) (HR: 0.74). After adjusting for age, performance status, primary tumour, metastatic status and GA-derived factors (function, nutrition and cognition), NLR (HR: 1.25, 95%CI: 1.03-1.52), PLR (HR: 1.34, 95%CI: 1.11-1.63) and LMR (HR: 0.79, 95%CI: 0.65-0.95) were associated with OS.

Conclusion

In our study of older cancer patients, we identified three key inflammatory markers (NLR >3.5, PLR >183.5, LMR <3.1) as strong predictors of poor OS. These markers remain predictive even after accounting for traditional prognostic factors and GA-derived scales.

Preoperative abnormal bone mineral density as a prognostic indicator in patients undergoing gastrectomy for gastric cancer: A cohort study

Predicting postgastrectomy relapse and mortality in patients with gastric cancer (GC) remains challenging, with limitations to traditional staging systems such as the tumor-node-metastasis (TNM) system. This study aimed to investigate the impact of preoperative Hounsfield unit (HU) values, which serve as a surrogate marker for bone mineral density (BMD), in predicting survival outcomes in patients with GC. A retrospective analysis was conducted on data from patients with GC who underwent curative-intent gastrectomy. Opportunistic abdominopelvic computed tomography images were used to assess HU values at the 3rd lumbar vertebra (L3). These values were then categorized using a cutoff value of 110 HU, which has been established in previous studies as a determinant for abnormal versus normal BMD. Cox regression analysis established predictor models for overall survival (OS). Among 501 initial patients, 478 met the inclusion criteria. Multivariate analyses revealed HU values (hazard ratio, 1.51), along with other factors (the 5-factor modified frailty index, type of gastrectomy, TNM stage, anemia, and serum albumin level), as significant predictors of OS. The full model (FM) incorporating these variables demonstrated superior discrimination ability compared to the baseline model (BM), which is based solely on the TNM stage (concordance index: 0.807 vs 0.709; P < .001). Furthermore, the FM outperformed the BM in predicting OS risks at 36- and 60-months post-surgery. In conclusion, among patients undergoing gastrectomy for GC, those with HU values ≤ 110 (indicating abnormal BMD) at the L3 level, as determined through opportunistic CT scans, exhibited a poorer prognosis than those with HU values > 110 (indicating normal BMD). Integrating HU with other clinicopathological parameters enhances predictive accuracy, facilitating individualized risk stratification and treatment decision-making, which could potentially lead to improved survival outcomes.

Pilot study: a detailed analysis of the timing of immuno-inflammatory indices in gastric cancer, and their assessment together with TNM as supplementary prognostic factors

An analysis of the prognostic impact of up to 36 immuno-inflammatory indices at 3 different times during the diagnostic-therapeutic process for gastric cancer. The dependent variable was disease-free survival at 3 years. The independent factors obtained were combined with TNM to provide an improved prognostic model.

Monocyte-to-lymphocyte ratio as a determinant of survival in patients with gastric cancer undergoing gastrectomy: A cohort study

The monocyte-to-lymphocyte ratio (MLR) is an important prognostic determinant of various malignancies. However, the prognostic role of MLR in patients with gastric cancer undergoing gastrectomy remains unclear. Patients with stage I to III gastric cancer who underwent curative-intent gastric resection were enrolled in this study. Cox regression analysis was used to determine the independent variables for overall survival (OS) and disease-free survival (DFS). The established models were validated internally. Inter-model comparisons were performed using the integrated area under the receiver operating characteristic curve and the concordance index. Multivariate Cox regression analysis revealed that age, tumor-node-metastasis (TNM) stage, perineural invasion, serum albumin level, and MLR were prognostic factors for OS and DFS and constituted the full model. The full model was internally validated using calibration curves and decision curve analysis. The integrated area under the curve and concordance index of the full model outperformed those of TNM stage. The full model was a significant determinant of OS and DFS. Additionally, the full model was suggested to outperform TNM stage in predicting patient survival outcomes.

Advanced lung cancer inflammation index (ALI) predicts prognosis of patients with gastric cancer after surgical resection

Introduction

Advanced lung cancer inflammation index (ALI) has been implicated in the prognosis of many types of tumors. But few studies elucidate its role in gastric cancer (GC).

Materials and methods

We consecutively recruited 615 GC patients who underwent radical gastrectomy. Patients were grouped according to ALI status. Risk factors for overall survival (OS) and disease-free survival (DFS) in overall and sex-stratified cohorts were determined using multivariate cox regression analysis. We also compared survival differences between the two groups after one-to-one propensity score matching (PSM).

Results

Patients with low ALI showed larger tumor size, more advanced TNM staging, shorter OS (median: 37 vs 42 months) and DFS (median: 37 vs 42 months) (all P < 0.001). Multivariate analysis showed that elevated ALI was independently associated with longer OS and DFS. After stratification by sex, low ALI was an independent risk factor for OS and DFS in male patients but not in female patients. But our further PSM analysis showed prognostic value of ALI in both male and female subgroups.

Conclusion

Preoperative ALI is an independent prognostic factor for GC patients undergoing curative gastrectomy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-09774-z.

The outcome of young vs. old gastric cancer patients following gastrectomy: a propensity score matching analysis

Purpose

The purpose of the current study was to compare the postoperative complications, overall survival and disease-free survival in young and old gastric cancer patients after gastrectomy using propensity score matching (PSM).

Methods

Adult patients (aged ≥ 18 years) who underwent gastrectomy for gastric cancer in a single clinical center from January 2013 to December 2017 were enrolled continuously for retrospective analysis. To minimize the selection bias between the young and old groups, the PSM was conducted in this study.

Results

A total of 558 patients were included in this study, with 51 patients in the young group (aged ≤ 45 years) and 507 patients in the old group (aged > 45 years). After 1:1 matching according to PSM, 51 patients in the young group were matched to 51 patients in the old group. After PSM, there was no difference in the baseline information. In terms of short-term outcomes, no difference was found in operation time (P = 0.190), intraoperative blood loss (P = 0.336), retrieved lymph nodes (P = 0.948), blood transfusion (P = 0.339), postoperative hospital stay (P = 0.194), or postoperative complications (P = 0.477) between the two groups. For overall survival, no statistically significant difference was found in all stages (P = 0.383), stage I (P = 0.431), stage II (P = 0.875) or stage III (P = 0.446) gastric cancer. Furthermore, regarding disease-free survival, no differences were found between the two groups in all stages (P = 0.378), stage I (P = 0.431), stage II (P = 0.879) or stage III (P = 0.510) gastric cancer.

Conclusion

Age might not be an independent prognostic factor for short-term outcomes, OS, or DFS in gastric cancer patients who underwent gastrectomy. The pTNM stage of GC might be an independent prognostic factor for OS and DFS.