Three-Tier Prognostic Index in Young Adults With Advanced Gastric Cancer

Guang-Liang Chen; Yan Huang; Wen Zhang; Xu Pan; Wan-Jing Feng; Xiao-Ying Zhao; Xiao-Dong Zhu; Wen-Hua Li; Mingzhu Huang; Zhi-Yu Chen; Wei-Jian Guo

doi:10.3389/fonc.2021.667655

Three-Tier Prognostic Index in Young Adults With Advanced Gastric Cancer

Front Oncol. 2021 Sep 10:11:667655. doi: 10.3389/fonc.2021.667655. eCollection 2021.

Authors

Guang-Liang Chen^{1

2}, Yan Huang³, Wen Zhang^{1

2}, Xu Pan⁴, Wan-Jing Feng^{1

2}, Xiao-Ying Zhao^{1

2}, Xiao-Dong Zhu^{1

2}, Wen-Hua Li^{1

2}, Mingzhu Huang^{1

2}, Zhi-Yu Chen^{1

2}, Wei-Jian Guo^{1

2}

Affiliations

¹ Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
² Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China.
³ Department of Oncology and Chemotherapy, Red Cross Hospital of Yulin City, Yulin, China.
⁴ Department of Medical Oncology, Yixing Traditional Chinese Medicine Hospital, Wuxi, China.

Abstract

Purpose: To characterize clinical features and identify baseline prognostic factors for survival in young adults with advanced gastric cancer (YAAGC).

Materials and methods: A total of 220 young inpatients (age less than or equal to 40 years) with an initial diagnosis of advanced gastric cancer were retrospectively enrolled in this study.

Results: Of a consecutive cohort of 220 patients with YAAGC, the median overall survival (OS) time was 16.3 months. One-year survival rate was 43.6% (95% CI: 36.5 to 50.7). In this cohort, a female (71.4%, n = 157) predominance and a number of patients with poorly differentiated tumors (95.9%, n = 211) were observed. In the univariate analysis, OS was significantly associated with neutrophil-lymphocyte ratio (NLR) (≥3.12), hypoproteinemia (<40 g/L), presence of peritoneal or bone metastases, and previous gastrectomy of primary tumor or radical gastrectomy. In multivariate Cox regression analysis, hypoproteinemia [hazard ratio (HR) 1.522, 95% CI 1.085 to 2.137, p = 0.015] and high NLR level (HR 1.446, 95% CI 1.022 to 2.047, p = 0.021) were two independent poor prognostic factors, while previous radical gastrectomy was associated with a favorable OS (HR 0.345, 95% CI 0.205 to 0.583, p = 0.000). A three-tier prognostic index was constructed dividing patients into good-, intermediate-, or poor-risk groups. Median OS for good-, intermediate-, and poor-risk groups was 36.43, 17.87, and 11.27 months, respectively.

Conclusions: Three prognostic factors were identified, and a three-tier prognostic index was devised. The reported prognostic index may aid clinical decision-making, patient risk stratification, and planning of future clinical studies on YAAGC.

Keywords: advanced gastric cancer; albumin; neutrophil–lymphocyte ratio; prognostic factors; young adults.