Preoperative albumin-bilirubin score is a prognostic factor for gastric cancer patients after curative gastrectomy

BACKGROUND Albumin-bilirubin(ALBI)score is an indicator of liver dysfunction and is useful for predicting prognosis of hepatocellular carcinomas.Currently,this liver function index has been used to predict prognosis in other neoplasms.However,the significance of ALBI score in gastric cancer(GC)after radical resection has not been elucidated.AIM To evaluate the prognostic value of the preoperative ALBI status in patients with GC who received curative treatment.METHODS Patients with GC who underwent curative intended gastrectomy were retrospectively evaluated from our prospective database.ALBI score was calculated as follows:(log10 bilirubin×0.660)+(albumin×-0.085).The receiver operating characteristic curve with area under the curve(AUC)was plotted to evaluate the ability of ALBI score in predicting recurrence or death.The optimal cutoff value was determined by maximizing Youden’s index,and patients were divided into low and high-ALBI groups.The Kaplan-Meier curve was used to analyze the survival,and the log-rank test was used for comparison between groups.RESULTS A total of 361 patients(235 males)were enrolled.The median ALBI value for the entire cohort was-2.89(IQR-3.13;-2.59).The AUC for ALBI score was 0.617(95%CI:0.556-0.673,P<0.001),and the cutoff value was-2.82.Accordingly,211(58.4%)patients were classified as low-ALBI group and 150(41.6%)as high-ALBI group.Older age(P=0.005),lower hemoglobin level(P<0.001),American Society of Anesthesiologists classification III/IV(P=0.001),and D1 lymphadenectomy P=0.003)were more frequent in the high-ALBI group.There was no difference between both groups in terms of Lauren histological type,depth of tumor invasion(pT),presence of lymph node metastasis(pN),and pathologic(pTNM)stage.Major postoperative complication,and mortality at 30 and 90 days were higher in the high-ALBI patients.In the survival analysis,the high-ALBI group had worse disease-free survival(DFS)and overall survival(OS)compared to those with low-ALBI(P<0.001).When stratified by pTNM,the difference between ALBI groups was maintained in stage I/II and stage III CG for DFS(P<0.001 and P=0.021,respectively);and for OS(P<0.001 and P=0.063,respectively).In multivariate analysis,total gastrectomy,advanced pT stage,presence of lymph node metastasis and high-ALBI were independent factors associated with worse survival.CONCLUSION The preoperative ALBI score is able to predict the outcomes of patients with GC,where high-ALBI patients have worse prognosis.Also,ALBI score allows risk stratification of patients within the same pTNM stages,and represents an independent risk factor associated with survival.

Remnant gastric cancer:An ordinary primary adenocarcinoma or a tumor with its own pattern?

BACKGROUND Remnant gastric cancer(RGC)is defined as a tumor that develops in the stomach after a previous gastrectomy and is generally associated with a worse prognosis.However,there little information available regarding RGCs and their prognostic factors and survival.AIM To evaluate the clinicopathological characteristics and prognosis of RGC after previous gastrectomy for benign disease.METHODS Patients who underwent curative resection for primary gastric cancer(GC)at our institute between 2009 and 2019 were retrospectively evaluated.All RGC resections with histological diagnosis of gastric adenocarcinoma were enrolled in this study.Primary proximal GC(PGC)who underwent total gastrectomy was selected as the comparison group.Clinical and pathological data were collected from a prospective medical database.RESULTS A total of 41 patients with RGC and 120 PGC were included.Older age(P=0.001),lower body mass index(P=0.006),hemoglobin level(P<0.001),and number of resected lymph nodes resected(LN)(P<0.001)were associated with the RGC group.Lauren type,pathological tumor-node-metastasis,and perioperative morbimortality were similar between RGC and PGC.There was no difference in disease-free survival(P=0.592)and overall survival(P=0.930)between groups.LN status was the only independent factor related to survival.CONCLUSION RGC had similar clinicopathological characteristics to PGC.Despite the lower number of resected LN,RGC had a similar prognosis.