Preoperative Body Mass Index, Blood Albumin and Triglycerides Predict Survival for Patients with Gastric Cancer.
BACKGROUND
Gastric cancer (GC) is common and its prognosis is often poor due to difficulties in early diagnosis and optimal treatment strategies. TNM staging system is useful in predicting prognosis but only possible after surgery. Therefore, it is desirable to investigate prognostic factors/markers that may predict prognosis before surgery by which helps appropriate management decisions preoperatively.


METHODS
A total of 320 GC patients were consecutively recruited from 2004 to 2013 and followed up for 127 months (10.6 years) after surgery. These patients' were examined for body mass index (BMI) and blood levels of albumin, triglyceride, total cholesterol, low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C). Kaplan-Meier method and log rank test were used to analyze long-term survival using the above potential risk markers. We first employed medians of these variables to reveal maximal potentials of the above prognostic predictors.


RESULTS
Three major findings were obtained: (1) Preoperative BMI was positively correlated with albumin (r = 0.144, P<0.05) and triglyceride (r = 0.365, P<0.01), but negatively correlated with TNM staging (r = -0.265, P<0.05). Preoperative albumin levels were positively correlated with triglyceride (r = 0.173, P<0.05) but again, negatively correlated with TNM staging (r = -0.137, P<0.05); (2) Poor survival was observed in GC patients with lower levels of BMI (P = 0.028), albumin (P = 0.004), and triglyceride (P = 0.043), respectively. Receiver operating characteristic (ROC) curve analyses suggested BMI, albumin and triglyceride to have survival-predictor powers similar to TNM system; and (3) Cox multi-factorial analyses demonstrated that age (P = 0.049), BMI (P = 0.016), cell differentiation (P = 0.001), and TNM staging (P = 0.011) were independent overall survival-predictors for GC patients.


CONCLUSIONS
Preoperative BMI, albumin, and triglyceride levels are capable of predicting survival for GC patients superior to postoperative TNM system in terms of timing for management. As potential survival-predictors, preoperative tests of BMI, albumin and triglyceride, combined with clinical imaging, may help personalized management for GC patients including planning surgical strategy, optimal radio-chemotherapy and appropriate follow-up intervals after surgery.
Department of Pathology, the First Affiliated University Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, China.|The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Shihezi University School of Medicine, Shihezi, Xinjiang, China.
Bin Zheng
BZ
Liu
Department of Pathology, the First Affiliated University Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, China.|The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Shihezi University School of Medicine, Shihezi, Xinjiang, China.
Lin
L
Tao
Department of Pathology, the First Affiliated University Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, China.|The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Shihezi University School of Medicine, Shihezi, Xinjiang, China.
Yun Zhao
YZ
Chen
Department of Pathology, the First Affiliated University Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, China.|The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Shihezi University School of Medicine, Shihezi, Xinjiang, China.
Xu Zhe
XZ
Li
Department of Pathology, the First Affiliated University Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, China.|The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Shihezi University School of Medicine, Shihezi, Xinjiang, China.
Yu Ling
YL
Dong
Clinical Laboratory, the First Affiliated University Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, China.
Ya Jing
YJ
Ma
Department of Preventive Medicine, Shihezi University School of Medicine, Shihezi, Xinjiang, China.
Shu Gang
SG
Li
Department of Pathology, the First Affiliated University Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, China.|Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Feng
F
Li
Department of Pathology, the First Affiliated University Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, China.|The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Shihezi University School of Medicine, Shihezi, Xinjiang, China.
Wen Jie
WJ
Zhang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011379:Prognosis; D012709:Serum Albumin / Q000378:metabolism*; D013274:Stomach Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D014280:Triglycerides / Q000097:blood*
D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D012709:Serum Albumin; D014280:Triglycerides