title: Novel immunological and nutritional-based prognostic index for gastric cancer.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  PNI is an independent prognostic factor for OS in gastric cancer. Canton score can be a novel preoperative prognostic index in gastric cancer.
authors.affiliation: 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.
authors.forename: Kai-Yu
authors.initials: KY
authors.lastname: Sun
authors.affiliation: 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.
authors.forename: Jian-Bo
authors.initials: JB
authors.lastname: Xu
authors.affiliation: 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.
authors.forename: Shu-Ling
authors.initials: SL
authors.lastname: Chen
authors.affiliation: 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.
authors.forename: Yu-Jie
authors.initials: YJ
authors.lastname: Yuan
authors.affiliation: 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.
authors.forename: Hui
authors.initials: H
authors.lastname: Wu
authors.affiliation: 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.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Peng
authors.affiliation: 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.
authors.forename: Chuang-Qi
authors.initials: CQ
authors.lastname: Chen
authors.affiliation: 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.
authors.forename: Pi
authors.initials: P
authors.lastname: Guo
authors.affiliation: 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.
authors.forename: Yuan-Tao
authors.initials: YT
authors.lastname: Hao
authors.affiliation: 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.
authors.forename: Yu-Long
authors.initials: YL
authors.lastname: He
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001792:Blood Platelets; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009504:Neutrophils / Q000276:immunology*; D015596:Nutrition Assessment; D009752:Nutritional Status; D010976:Platelet Count; D011237:Predictive Value of Tests; D057216:Propensity Score; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Canton score; Gastric cancer; Neutrophil-lymphocyte ratio; Platelet-lymphocyte ratio; Prognosis; Prognostic nutritional index