Importance of Novel Gastric Cancer Prognostic Index in Patients with Locally Advanced Gastric Cancer Who Underwent Radical Gastrectomy and Chemoradiotherapy

Abstract

Aim: To investigate the significance of the novel gastric cancer prognostic index, which combines albumin and metastatic lymph node count, on the outcomes of patients with locally advanced gastric cancer who received radical gastrectomy and concurrent chemoradiotherapy. Method: Patients who received concurrent chemoradiotherapy following radical gastrectomy between January 2014 and December 2019 were included in this retrospective analysis. According to the literature, the ideal cutoff value for albumin was determined to be 3.5 g/dL. Meanwhile, the optimal cutoff value for metastatic lymph node count was determined using receiver operating characteristic curve analysis. Results: This retrospective study comprised 137 locally advanced gastric cancer patients. The ideal albumin cutoff value was chosen to be the classically referred 3.5 g/dL (< 3.5 versus ≥ 3.5 g/dL), while the results of the receiver operating characteristic curve analysis revealed the ideal metastatic lymph node count cutoff value as 5 (< 5 versus ≥ 5). Hence, the study population was divided into four possible groups: Group 1: albumin ≥ 3.5 g/dL and metastatic lymph node count < 5, Group 2: albumin ≥ 3.5 g/dL and metastatic lymph node count ≥ 5, Group 3: albumin < 3.5 g/dL and metastatic lymph node count < 5, and Group 4: albumin < 3.5 g/dL and metastatic lymph node count ≥ 5. Since there was no significant difference between Group 2 and Group 3 in the analysis, they were combined to create gastric cancer prognostic index-2. The Kaplan-Meier curves revealed that gastric cancer prognostic index-1 and gastric cancer prognostic index-3 had significant differences in progression-free survival (66.0 versus 16.4 months; P < 0.001) and overall survival (66.0 versus 19.5 months, P < 0.001), respectively. The results of the multivariate analysis confirmed the gastric cancer prognostic index grouping’s independent prognostic significance for overall survival (P < 0.001) and progression-free survival (P = 0.05) outcomes. Conclusion: The novel gastric cancer prognostic index may be utilized as an independent and precise prognostic indicator.