The prognostic value of pretreatment inflammatory and nutrition-related indices in patients with cardia cancer

Wenjuan Guo¹Jinwei Zhao²Ning Li^1*Jing Wang^1*

• ¹Department of Radiation Oncology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
• ²Department of Pharmacy, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Tayuan, China

Objective: To evaluate the prognostic significance of inflammatory and nutrition-related indexes in patients with cardia cancer prior to treatment. Methods: A total of 229 patients with cardia cancer, diagnosed pathologically and admitted to Shanxi Cancer Hospital between January 2017 and December 2018, were included. The optimal cut-off values for body mass index (BMI), peripheral blood platelet-to-lymphocyte ratio (PLR), hemoglobin-to-erythrocyte distribution width ratio (HRR), prognostic nutritional index (PNI), and integrating hemoglobin, albumin, lymphocyte, and platelets (HALP) score were determined with X-tile 3.6.1 software. Survival analysis was performed using the Kaplan-Meier method, with variability assessed by the Log-rank test. Univariate and multivariate Cox proportional hazards regression analyses were used to evaluate the prognostic value of the variables. Relative weights of selected variables determined the prognostic risk stratification model. The predictive value of the model was assessed using receiver operating characteristic (ROC) curves. Results: The optimal critical values of BMI, PLR, HRR, PNI, and HALP score were 20.43, 140.59, 2.85,49.98, and 28.23, respectively. Cox univariate analysis showed that age, TNM stage, treatment regimen, BMI, PLR, HRR, PNI, and HALP score were correlated with the prognosis of patients with cardia cancer (P < 0.05). The results of Cox multifactorial analysis showed that age, TNM stage, treatment regimen, HRR, and PNI were independent factors (P < 0.05). The patients were categorized as low-risk, intermediate-risk, high-risk, and very-high-risk groups based on the five variables' HRs. The median survival times for the four groups were undefined, 18.05 months, 15.63 months, and 9.10 months, respectively (P < 0.05). The area under the curve (AUC) of the prognostic risk stratification model was 0.80, which was higher than those for age (0.56), TNM stage (0.63), treatment regimen (0.73), HRR (0.57), and PNI (0.63). Conclusion: Pre-treatment inflammatory and nutrition-related indexes, HRR and PNI, were closely associated with the prognosis of patients with cardia cancer. Combining age, TNM stage, treatment regimen, HRR, and PNI for prognostic risk stratification could significantly enhance the accuracy of prognostic predictions.