ABSTRACT
Objective:To explore the values of albumin-bilirubin (ALBI) score, carcinoembryonic antigen (CEA) and combination of the two in the prognostic assessment of colorectal cancer patients with postoperative liver metastasis.Methods:The clinicopathological data of 98 colorectal cancer patients with postoperative liver metastasis who were admitted to Lianyungang Oriental Hospital and receiving adjuvant chemotherapy from January 2016 to March 2020 were retrospective analyzed. The data of serum protein, bilirubin, and CEA before chemotherapy were obtained, the relationship between serum protein and bilirubin was analyzed, and the ALBI score was calculated. The ALBI-CEA score was judged according to the ALBI score and the CEA level. ALBI score > -2.60 points was categorized as high ALBI group, and ALBI score ≤ -2.60 points was categorized as low ALBI group; CEA >5 ng/ml was categorized as high CEA group, and CEA ≤5 ng/ml was categorized as low CEA group; patients were categorized into 0, 1, and 2 points groups based on ALBI-CEA score. Overall survival (OS) and progression-free survival (PFS) of ALBI score, CEA and ALBI-CEA score subgroups were analyzed by Kaplan-Meier method; with the actual survival and progress status of the patients as the gold standard, receiver operating characteristic (ROC) curve was used to analyze the effect of 3 indicators to assess patients' OS and PFS, and area under the curve (AUC) was compared; Cox proportional hazards model was used to analyze the influencing factors of OS and PFS.Results:The median albumin and bilirubin levels of the 98 patients were 34.4 g/L (26.8-42.8 g/L) and 16.6 μmol/L (7.6-44.6 μmol/L), and the result of Pearson correlation analysis showed a negative correlation between the levels of albumin and bilirubin ( r = -0.282, P < 0.001). The 3-year OS and PFS rates in the high ALBI group were lower than those in the low ALBI group (OS rate: 9.2% vs. 33.3%, PFS rate: 7.7% vs. 18.2%), and the differences in OS and PFS between the two groups were statistically significant ( χ2 values were 27.64, 23.30, both P < 0.001). The 3-year OS and PFS rates in the high CEA group were lower than those in the low CEA group (OS rate: 7.1% vs. 42.9%, PFS rate: 7.1% vs. 21.4%), and the differences in OS and PFS between the two groups were statistically significant ( χ2 values were 23.71, 17.14, both P < 0.001). The 3-year OS rates in the ALBI-CEA score 0, 1 and 2 points groups were 77.8%, 20.9% and 2.2%, and the 3-year PFS rates were 44.4%, 9.3% and 6.5%, and there were statistical differences in OS and PFS among the three groups ( χ2 values were 102.36, 76.55, both P < 0.001). The ROC curve analysis showed that the AUC of ALBI score, CEA and ALBI-CEA score for assessing OS were 0.688 (95% CI 0.544-0.832), 0.754 (95% CI 0.618-0.890) and 0.828 (95% CI 0.723-0.933) (all P < 0.05), and the AUC for assessing PFS were 0.618 (95% CI 0.436-0.799), 0.646 (95% CI 0.464-0.829) and 0.682 (95% CI 0.494-0.870) (all P > 0.05). Multivariate Cox regression analysis showed that ALBI-CEA score was an independent influencing factor for OS (2 points vs. 0 point: HR = 17.254, 95% CI 8.385-35.504, P < 0.001) and PFS (2 points vs. 0 point: HR = 6.144, 95% CI 3.725-10.134, P < 0.001) of patients. Conclusions:The colorectal cancer patients with liver metastasis and high ALBI-CEA score are at high risk of death and disease progression and have a poor prognosis, and they are recommended to receive intensive treatment.
ABSTRACT
Objective:To investigate the correlation among prognostic nutritional index (PNI), clinical features, and adverse reac-tions after adjuvant chemotherapy of gastric cancer patients who underwent radical gastrectomy. Furthermore, this study aimed to clari-fy the predictive and prognostic significance of PNI in patients who underwent gastrectomy for gastric cancer. Methods:This study re-viewed the medical records of 148 patients with gastric cancer who underwent gastrectomy. The PNI value was calculated by serum al-bumin concentration (g/L)+5 × lymphocyte count (×109/L). The receiver operating characteristic (ROC) curve and Youden index were used to determine the cut-off value of the PNI. Survival curves were described by Kaplan-Meier method and compared by Log-rank test. The univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the prognostic factors. Re-sults:The mean values of the PNI in<65 years old patients (P<0.01), T1 and T2 stages of tumor (P<0.01), and negative lymph node (P=0.013) were significantly higher than those without such factors. Patients with higher PNI had significantly lower rates of postoperative complication and adjuvant chemotherapy adverse reactions than those with lower PNI (P<0.01). When the PNI value was 52.08, the Youden index was maximal, with a sensitivity of 66.7%and a specificity of 34.3%. The overall survival rate in the high PNI group was higher than that in the low PNI group (P<0.01). The univariate and multivariate analyses showed that preoperative carcinoembryonic antigen level (P=0.018), tumor depth (P=0.010), intravascular cancer embolus (P=0.010), time to initiation of chemotherapy after sur-gery (P=0.034), and the PNI value (P=0.015) were independent factors in predicting overall survival rate. Conclusion:The PNI value was a simple and useful tool to predict the prognosis and the incidence of adjuvant chemotherapy adverse reactions of gastric cancer pa-tients after radical gastrectomy.