title: Albumin concentrations plus neutrophil lymphocyte ratios for predicting overall survival after curative resection for gastric cancer.
abstract: BACKGROUND
  In patients with gastric cancer (GC), survival is poor, given the late diagnosis. Risk-stratifying these patients earlier could help improve care. We determined whether combining preoperative albumin concentration and the neutrophil lymphocyte ratio (COA-NLR) could predict overall survival (OS) better than other prognostic indexes.
  
  
  METHODS
  We calculated the COA-NLR and other prognostic indexes with data obtained within 1 week before surgery in a retrospective analysis of patients with GC undergoing curative resection between September 2000 and November 2012. Patients with concentrations of hypoalbuminemia above 35 g/L and an NLR value of 2.3 or higher were given a score of 2. Patients with one of these conditions or neither were allocated scores of 1 or 0, respectively. Patients were monitored until July 2014.
  
  
  RESULTS
  OS in the 873 eligible patients was 44.9% in patients with a COA-NLR score of 0, 29.8% in patients with a score of 1, and 20.3% in patients with a score of 2 (P<0.001). The COA-NLR score was independently associated with OS (hazard ratio, 1.35; 95% confidence interval, 1.12 to 1.63; P=0.002). Moreover, the area under the receiver operating characteristics curve was 0.62 for the COA-NLR, which was significantly higher (<0.001) than that of the NLR ratio (0.60), the Glasgow prognostic score (0.58), and the platelet lymphocyte ratio (0.54). The COA-NLR was especially accurate for patients with stage I-II GC and the three values (0, 1, and 2) divided patients into subgroups more accurately than did the other indexes (area under the curve value: 0.66, P<0.001).
  
  
  CONCLUSIONS
  The preoperative COA-NLR index is useful for predicting postoperative OS in patients with GC and can be used to guide targeted therapy.
authors.affiliation: State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine; Department of Gastric and Pancreatic Surgery.
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Sun
authors.affiliation: State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine; Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.
authors.forename: Juncheng
authors.initials: J
authors.lastname: Wang
authors.affiliation: State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine; Department of Gastric and Pancreatic Surgery.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine; Department of Gastric and Pancreatic Surgery.
authors.forename: Shangxiang
authors.initials: S
authors.lastname: Chen
authors.affiliation: State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine; Department of Gastric and Pancreatic Surgery.
authors.forename: Xuechao
authors.initials: X
authors.lastname: Liu
keywords: adjuvant chemotherapy; albumin concentration; gastric cancer; neutrophil-to-lymphocyte ratio; prognosis