| Background and ObjectiveGastric cancer(GC)is a heterogeneous and multifactorial disease,which is considered to be the fifth most common cancer and the third largest cause of cancer-related death in the world.According to previous reports,gastric cancer has a high incidence and mortality,which is one of the most common causes of cancer death in the world.Although the long-term survival rate of gastric cancer has been greatly improved in recent decades with the improvement of living conditions and dietary structure,the incidence of gastric cancer in China is still high and the overall prognosis is still very poor.This is not only due to the late appearance of symptoms in patients with advanced(metastatic)diseases,but also to the lack of effective prognostic indicators in the early stage.At present,more and more evidence shows that host inflammatory response plays an important role in the occurrence and development of cancer,especially the systemic inflammatory response characterized by the elevated level of serum C-reactive protein(CRP)is a key factor in the progression of various common solid tumors.at the same time,persistent systemic inflammatory response in patients with advanced malignant tumors leads to hypoalbuminemia,which is also an important reason for poor tumor prognosis.The combination of two biomarkers,CRP and serum albumin(ALB),is called the Glasgow prognosis score(GPS),which is defined as:patients with elevated CRP(>10 mg/L)and hypoalbuminemia(<35g/L)are divided into two groups;patients with only one abnormal index in the two biochemical tests were divided into 1 group;and patients who do not show these abnormal serum values are divided into group 0.The main purpose of this study is to explore the relationship between Glasgow prognostic score and postoperative prognosis of patients with gastric cancer by analyzing the relationship between GPS and clinicopathological features and the relationship between GPS and survival rate in patients with gastric cancer who underwent radical operation.Object and methodsPatients who were diagnosed with gastric cancer in the First Affiliated Hospital of Zhengzhou University-2020 and underwent radical gastric cancer resection and D2 lymph node dissection between 2016-2020 were selected as the research subjects.Selection criteria:1.Patients whose postoperative pathology was confirmed to be feasible for radical resection of gastric cancer;2.Patients who have recorded CRP、ALB before surgery,and the relevant clinicopathological data were tested within 1 week before surgery.Exclusion criteria:1.Patients with distant metastases without radical gastric cancer resection;2.Patients with other tumors 3,Patients who have undergone preoperative neoadjuvant therapy such as radiotherapy or chemotherapy;4.Patients with abnormal CRP、ALB index due to other factors(except gastric cancer);5.Patients who died within 1 month after surgery;recorded patient age,gender,CA72-4、CEA、ALB、CRP、nerve infiltration,vascular infiltration,tumor differentiation degree、tumor TNM stage(version 8),clinical stage,postoperative follow-up through outpatient review,telephone follow-up.Patients were divided into the following 3 groups according to serum CRP and ALB levels:1,GPS0:both normal(CRP≦10 mg/L、ALB≧35 g/L);2;GPS 1:1 abnormal(CRP>1Omg/L or ALB<35g/L);3,GPS 2:both abnormal(CRP>10 mg/L and ALB<35g/L).Cube test was used,Kaplan-Meier for patient survival curve drawing,log-rank for intergroup survival comparison,and COX proportional regression model was used for multivariate survival analysis and hazard ratio calculation.The difference was statistically significant(P<0.05).Results1.Among the 109 patients,there were 74 males and 35 females,with a median age of 55(48.5～66.0)years old,including 69 cases in GPS0 group,29 cases in GPS 1 group and 11 cases in GPS2 group.During the follow-up period from 3.0 to 60.0 months,0 patients lost follow-up,25 patients with gastric cancer relapsed,33 patients died,and 76 patients survived until the end of follow-up.2.Chi-square test was used to compare the relationship between GPS and clinical data of patients.The results showed that there were significant differences between GPS and CA72-4(P<0.05),nerve infiltration(P<0.05),tumor differentiation(ALB(P<0.05),CRP(P<0.05).But there was no significant difference between age,sex,CEA,vascular invasion and clinical stage.3.The relationship between clinicopathological data and postoperative 5-year survival rate was analyzed by univariate analysis.the results showed that the postoperative survival rate was related to the following factors.They were age(P<0.05),nerve infiltration(P<0.05),tumor differentiation(P<0.05),clinical stage(P<0.05),ALB(P<0.05),CRP(P<0.05)and GPS score(P<0.05).The survival rate of the elderly group was 59.6%and that of the younger group was 77.4%;The survival rate was 30.6%in the positive group,89.0%in the negative group;68.6%in the low differentiation group,100.0%in the low-medium differentiation group,50.0%in the medium-low differentiation group,and 84.8%in the moderate differentiation group;Clinical stage I group 94.1%pint ⅡA group 75.0%pint ⅡB group 84.2%pint Ⅲ group 57.4%;The GPS0 group was 87.0%,the first group was 48.3%,the second group was 18.2%.On the contrary,there was no significant relationship between postoperative survival rate and gender,CA724,CEA and vascular invasion.4.The results of multivariate analysis showed that the postoperative survival rate was independently correlated with GPS score(OR=3.246,95%CI:1.899～5.547,P<0.05)and nerve infiltration(OR=6.427,95%CI:2.595～15.920,P<0.05).There was significant difference in postoperative survival rate among GPS 0,1 and 2 subgroups,and the 5-year survival rate decreased gradually with the increase of GPS score.GPS can be considered as an independent predictor of survival after radical resection of gastric cancer.ConclusionGPS is an independent predictor of postoperative survival prognosis in patients with gastric cancer.With the increase of GPS score,the postoperative survival rate gradually decreases,so GPS can be used as a routine preoperative examination to evaluate the postoperative survival prognosis of patients with gastric cancer,so as to better make corresponding clinical decisions. |
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