Objectives: Albumin-globulin ratio (AGR), prognostic nutritional index (PNI), and platelet-to-lymphocyte ratio (PLR) have been validated as prognostic factors for gastric cancer (GC). However, significant gender differences exist in albumin levels and inflammatory cell counts, and further research is required to understand how these differences influence GC prognosis. This study aims to investigate the prognostic impact of nutritional and inflammatory indicators on GC patients undergoing radical surgery, as well as the influence of gender on these indicators' prognostic value.
Methods: The study included 596 patients with advanced GC hospitalized in the Department of Gastrointestinal Surgery, General Surgery, Xiangya Hospital of Central South University from January 2012 to December 2016. Receiver operating characteristic (ROC) analysis was performed to determine cutoff values for nutritional and inflammatory factors. Univariate analysis was used to identify factors significantly affecting survival in GC patients, while multivariate and Kaplan-Meier analyses determined independent prognostic factors for GC.
Results: Multivariate analysis revealed that postsurgical tumor node metastasis (pTNM) stage [stage II: hazard ratio (HR)=3.284, P=0.012; stage III: HR: 8.062, P<0.001], low preoperative AGR (HR=1.499, P=0.012), and postoperative PNI (HR=1.503, P=0.008) were risk factors for overall survival in male patients after radical GC surgery. For female patients, pN2-3 (HR=3.185, P<0.001), total gastrectomy (HR=2.286, P=0.004), low preoperative PLR (HR=1.702, P=0.027), and postoperative PNI (HR=1.943, P=0.011) were identified as risk factors for overall survival.
Conclusions: Postoperative PNI is an independent risk factor for all advanced GC patients. Preoperative PLR is an independent prognostic factor only for female patients, while preoperative AGR is an independent prognostic factor only for male patients. Further research is warranted to investigate the gender-specific differences in GC prognosis.
目的: 白蛋白-球蛋白比(albumin-globulin ratio，AGR)、预后营养指数(prognostic nutritional index，PNI)和血小板-淋巴细胞比(platelet-to-lymphocyte ratio，PLR)已被证明是胃癌(gastric cancer，GC)的有效预后因素。然而，性别在白蛋白水平和炎症细胞水平上存在显著差异，这些差异如何反映在GC患者的预后中还需要进一步研究。本研究旨在探讨营养和炎症指标对GC根治性手术前后GC患者预后的影响，以及性别对上述指标预后能力的影响。方法: 纳入2012年1月至2016年12月在中南大学湘雅医院普外胃肠外科住院的596例晚期GC患者。使用营养和炎症因子进行受试者操作特征(receiver operating characteristic，ROC)分析以获得临界值。通过单因素分析找到显著影响GC患者生存的因素，通过多因素分析和Kaplan-Meier分析确定GC的独立预测因素。结果: 多因素分析显示，术后肿瘤淋巴结转移(postsurgical tumor node metastasis，pTNM)分期[II期：风险比(hazard ratio，HR)=3.284，P=0.012；III期：HR=8.062，P<0.001]、术前AGR低(HR=1.499，P=0.012)、术后PNI(HR=1.503，P=0.008)是影响男性患者GC根治术后总生存的危险因素；pN2-3(HR=3.185，P<0.001)、全胃切除术(HR=2.286，P=0.004)、术前PLR低(HR=1.702，P=0.027)、术后PNI低(HR=1.943，P=0.011)是影响女性患者GC根治术后总生存期的危险因素。结论: 术后PNI是所有晚期GC患者的独立危险因素，术前PLR仅为女性患者的独立预后因素，术前AGR仅为男性患者的独立预后因素。GC预后的性别差异有待进一步研究。.
目的: 白蛋白-球蛋白比(albumin-globulin ratio，AGR)、预后营养指数(prognostic nutritional index，PNI)和血小板-淋巴细胞比(platelet-to-lymphocyte ratio，PLR)已被证明是胃癌(gastric cancer，GC)的有效预后因素。然而，性别在白蛋白水平和炎症细胞水平上存在显著差异，这些差异如何反映在GC患者的预后中还需要进一步研究。本研究旨在探讨营养和炎症指标对GC根治性手术前后GC患者预后的影响，以及性别对上述指标预后能力的影响。
方法: 纳入2012年1月至2016年12月在中南大学湘雅医院普外胃肠外科住院的596例晚期GC患者。使用营养和炎症因子进行受试者操作特征(receiver operating characteristic，ROC)分析以获得临界值。通过单因素分析找到显著影响GC患者生存的因素，通过多因素分析和Kaplan-Meier分析确定GC的独立预测因素。
结果: 多因素分析显示，术后肿瘤淋巴结转移(postsurgical tumor node metastasis，pTNM)分期[II期：风险比(hazard ratio，HR)=3.284，P=0.012；III期：HR=8.062，P<0.001]、术前AGR低(HR=1.499，P=0.012)、术后PNI(HR=1.503，P=0.008)是影响男性患者GC根治术后总生存的危险因素；pN2-3(HR=3.185，P<0.001)、全胃切除术(HR=2.286，P=0.004)、术前PLR低(HR=1.702，P=0.027)、术后PNI低(HR=1.943，P=0.011)是影响女性患者GC根治术后总生存期的危险因素。
结论: 术后PNI是所有晚期GC患者的独立危险因素，术前PLR仅为女性患者的独立预后因素，术前AGR仅为男性患者的独立预后因素。GC预后的性别差异有待进一步研究。
Keywords: advanced gastric cancer; albumin-globulin ratio; platelet-lymphocyte ratio; prognosis; prognostic nutritional index.