Öz
Objective: Gastric cancer (GC) is a cancer with poor prognosis despite advances in diagnosis and treatment methods, and postoperative morbidity and mortality rates are high. The aim of this study was to evaluate the predictive and early prognostic effect of the pre-treatment albumin to globulin ratio (AGR) in patients with gastric adenocarcinoma (GAC).
Methods: The study included male and female patients who were operated on with the diagnosis of GAC in our general surgery clinic between January 2016 and November 2020. The demographic and postoperative histopathological findings, postoperative complications, and in-hospital mortality findings of the patients were evaluated retrospectively from the hospital data.
Results: Evaluation was made of a total of 70 patients operated on with the diagnosis of GAC. In the ROC curve analysis applied to the AGR ratio, the optimum cut-off value was 1.54. A statistically significant difference was found between the high (≥1.54) and low (<1.54) AGR groups in terms of intensive care unit (ICU) length of stay, serious postoperative complications, anastomotic leakage, and in-hospital mortality (p = 0.050, p = 0.016, p = 0.011; p = 0.005). In univariate analysis with postoperative serious complications, statistically significant results were found with age> 65 years, high American Society of Anesthesiologist (ASA) score, and low AGR (p = 0.035, p <0.001, p = 0.016), whereas in multivariate analysis, only high ASA score was found to be an independent risk factor (p = 0.031).
Conclusion: The results of this study demonstrated the relationship between low AGR and serious postoperative complications, anastomotic leakage and early mortality risk in GAC. The AGR ratio, which can be calculated from the albumin and globulin values used in routine clinical practice, can be used as a suitable prognostic factor in this patient group to enable the clinician to take the necessary preoperative precautions.
Anahtar Kelimeler
Gastric adenocarcinoma albumin / globulin ratio postoperative complication
Kaynakça
- 1. Venerito M, Link A, Rokkas T, Malfertheiner P. Review: Gastric cancer-Clinical aspects. Helicobacter. 2019;24 Suppl 1:e12643.
- 2. In H, Solsky I, Palis B, Langdon-Embry M, Ajani J, Sano T. Validation of the 8th Edition of the AJCC TNM Staging System for Gastric Cancer using the National Cancer Database. Ann Surg Oncol. 2017;24(12):3683-91.
- 3. Durhan A, Durhan G, Eroğlu A. Regression in local recurrence in the contralateral breast following mastectomy in bilateral locally advanced breast cancer: A comparison of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios. Turkish journal of surgery. 2018;34(2):140-2.
- 4. Sun J, Chen X, Gao P, Song Y, Huang X, Yang Y, et al. Can the Neutrophil to Lymphocyte Ratio Be Used to Determine Gastric Cancer Treatment Outcomes? A Systematic Review and Meta-Analysis. Dis Markers. 2016;2016:7862469.
- 5. Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212-22.
- 6. Jia J, Zheng X, Chen Y, Wang L, Lin L, Ye X, et al. Stage-dependent changes of preoperative neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in colorectal cancer. Tumour Biol. 2015;36(12):9319-25.
- 7. Bozkaya Y, Erdem GU, Demirci NS, Yazıcı O, Özdemir NY, Köstek O, et al. Prognostic importance of the albumin to globulin ratio in metastatic gastric cancer patients. Current medical research and opinion. 2019;35(2):275-82.
- 8. Lv GY, An L, Sun XD, Hu YL, Sun DW. Pretreatment albumin to globulin ratio can serve as a prognostic marker in human cancers: a meta-analysis. Clinica chimica acta; international journal of clinical chemistry. 2018;476:81-91.
- 9. Guo HW, Yuan TZ, Chen JX, Zheng Y. Prognostic value of pretreatment albumin/globulin ratio in digestive system cancers: A meta-analysis. PLoS One. 2018;13(1):e0189839.
- 10. Ai S, Sun F, Liu Z, Yang Z, Wang J, Zhu Z, et al. Change in serum albumin level predicts short-term complications in patients with normal preoperative serum albumin after gastrectomy of gastric cancer. ANZ journal of surgery. 2019;89(7-8):E297-e301.
- 11. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13.
- 12. Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol. 2006;24(14):2137-50.
- 13. Lai CC, You JF, Yeh CY, Chen JS, Tang R, Wang JY, et al. Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis. 2011;26(4):473-81.
- 14. Siddiqui A, Heinzerling J, Livingston EH, Huerta S. Predictors of early mortality in veteran patients with pancreatic cancer. Am J Surg. 2007;194(3):362-6.
- 15. Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutrition journal. 2010;9:69.
- 16. Chen Z, Shao Y, Yao H, Zhuang Q, Wang K, Xing Z, et al. Preoperative albumin to globulin ratio predicts survival in clear cell renal cell carcinoma patients. Oncotarget. 2017;8(29):48291-302.
- 17. Xiao S, Feng F, Liu N, Liu Z, Guo Y, Lian X, et al. Preoperative Albumin Level Is Superior To Albumin-Globulin Ratio As A Predicting Indicator In Gastric Cancer Patients Who Underwent Curative Resection. Cancer Manag Res. 2019;11:9931-8.
- 18. Alkan A, Köksoy EB, Utkan G. Albumin to globulin ratio, a predictor or a misleader? Annals of oncology : official journal of the European Society for Medical Oncology. 2015;26(2):443-4.
- 19. Pfensig C, Dominik A, Borufka L, Hinz M, Stange J, Eggert M. A New Application for Albumin Dialysis in Extracorporeal Organ Support: Characterization of a Putative Interaction Between Human Albumin and Proinflammatory Cytokines IL-6 and TNFα. Artificial organs. 2016;40(4):397-402.
- 20. Azab B, Kedia S, Shah N, Vonfrolio S, Lu W, Naboush A, et al. The value of the pretreatment albumin/globulin ratio in predicting the long-term survival in colorectal cancer. Int J Colorectal Dis. 2013;28(12):1629-36.
- 21. Guo YZ, Pan L, Du CJ, Ren DQ, Xie XM. Association between C-reactive protein and risk of cancer: a meta-analysis of prospective cohort studies. Asian Pac J Cancer Prev. 2013;14(1):243-8.
- 22. Kristal AR, Schenk JM, Song Y, Arnold KB, Neuhouser ML, Goodman PJ, et al. Serum steroid and sex hormone-binding globulin concentrations and the risk of incident benign prostatic hyperplasia: results from the prostate cancer prevention trial. Am J Epidemiol. 2008;168(12):1416-24.
- 23. Huang R, Ma Y, Holm R, Trope CG, Nesland JM, Suo Z. Sex hormone-binding globulin (SHBG) expression in ovarian carcinomas and its clinicopathological associations. PLoS One. 2013;8(12):e83238.
- 24. Chen J, Zhou Y, Xu Y, Zhu HY, Shi YQ. Low pretreatment serum globulin may predict favorable prognosis for gastric cancer patients. Tumour Biol. 2016;37(3):3905-11.
- 25. Liu J, Chen S, Geng Q, Liu X, Kong P, Zhan Y, et al. Prognostic value of pretreatment albumin-globulin ratio in predicting long-term mortality in gastric cancer patients who underwent D2 resection. OncoTargets and therapy. 2017;10:2155-62.
Öz
Amaç: Gastrik kanser (GK), tanı ve tedavi metodlarındaki gelişmelere rağmen kötü prognozlu bir kanser olup, postoperatif morbidite ve mortalite oranları yüksek seyretmektedir. Bu çalışmada tedavi öncesi bakılan albümin-globülin oranı (AGO)’ nun gastrik adeno kanser (GAK) hastalarındaki prediktif ve erken dönem prognostik etkisini değerlendirmeyi amaçladık.
Metod: Ocak 2016 ile kasım 2020 arasında, genel cerrahi kliniğimizde GAK tanısı ile opere edilen kadın ve erkek hastalar çalışmaya dahil edildi. Hastaların demografik ve postoperatif histopatolojik bulguları, postoperatif komplikasyonları ve hastane içi mortalite bulguları hastane veri datasından retrospektif olarak değerlendirildi.
Bulgular: GAK tanısı ile ameliyat edilen toplam 70 hastanın değerlendirmesi yapıldı. AGO oranına uygulanan ROC eğri analizinde en uygun kesme değeri 1.54 idi. Yüksek (≥1.54) ve düşük (<1.54) AGO grupları arasında yoğun bakım ünitesi (YBÜ) kalış süresi, postoperatif ciddi komplikasyon, anastomoz kaçağı ve hastane içi mortalite gelişimi için istatisksel anlamlı fark tespit edildi ( p=0.050, p=0.016, p=0.011; p=0.005). Postoperatif ciddi komplikasyon ile univarite analizde >65 yaş, yüksek American Society of Anesthesiologist (ASA) skoru ve düşük AGO ile istatsisksel anlamlı sonuç bulunurken ( p=0.035, p<0.001, p=0.016), multivarite analizde ise sadece yüksek ASA skoru, bağımsız risk faktörü olarak bulundu ( p=0.031).
Sonuç: AGO ile GAK’ da postoperatif ciddi komplikasyon, anastomoz kaçağı ve erken mortalite riski arasındaki ilişki çalışmamızda ortaya konmuş , bu hasta grubunda rutin klinik pratikle ölçülebilen düşük maliyetli AGO oranı preoperatif dönemde klinisyeni gerekli önlemleri alması için uyaran uygun bir prognostik araç olarak kullanılabilir.
Anahtar Kelimeler
Gastrik adenokanser albümin / globülin oranı postoperatif komplikasyon
Kaynakça
- 1. Venerito M, Link A, Rokkas T, Malfertheiner P. Review: Gastric cancer-Clinical aspects. Helicobacter. 2019;24 Suppl 1:e12643.
- 2. In H, Solsky I, Palis B, Langdon-Embry M, Ajani J, Sano T. Validation of the 8th Edition of the AJCC TNM Staging System for Gastric Cancer using the National Cancer Database. Ann Surg Oncol. 2017;24(12):3683-91.
- 3. Durhan A, Durhan G, Eroğlu A. Regression in local recurrence in the contralateral breast following mastectomy in bilateral locally advanced breast cancer: A comparison of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios. Turkish journal of surgery. 2018;34(2):140-2.
- 4. Sun J, Chen X, Gao P, Song Y, Huang X, Yang Y, et al. Can the Neutrophil to Lymphocyte Ratio Be Used to Determine Gastric Cancer Treatment Outcomes? A Systematic Review and Meta-Analysis. Dis Markers. 2016;2016:7862469.
- 5. Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212-22.
- 6. Jia J, Zheng X, Chen Y, Wang L, Lin L, Ye X, et al. Stage-dependent changes of preoperative neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in colorectal cancer. Tumour Biol. 2015;36(12):9319-25.
- 7. Bozkaya Y, Erdem GU, Demirci NS, Yazıcı O, Özdemir NY, Köstek O, et al. Prognostic importance of the albumin to globulin ratio in metastatic gastric cancer patients. Current medical research and opinion. 2019;35(2):275-82.
- 8. Lv GY, An L, Sun XD, Hu YL, Sun DW. Pretreatment albumin to globulin ratio can serve as a prognostic marker in human cancers: a meta-analysis. Clinica chimica acta; international journal of clinical chemistry. 2018;476:81-91.
- 9. Guo HW, Yuan TZ, Chen JX, Zheng Y. Prognostic value of pretreatment albumin/globulin ratio in digestive system cancers: A meta-analysis. PLoS One. 2018;13(1):e0189839.
- 10. Ai S, Sun F, Liu Z, Yang Z, Wang J, Zhu Z, et al. Change in serum albumin level predicts short-term complications in patients with normal preoperative serum albumin after gastrectomy of gastric cancer. ANZ journal of surgery. 2019;89(7-8):E297-e301.
- 11. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13.
- 12. Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol. 2006;24(14):2137-50.
- 13. Lai CC, You JF, Yeh CY, Chen JS, Tang R, Wang JY, et al. Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis. 2011;26(4):473-81.
- 14. Siddiqui A, Heinzerling J, Livingston EH, Huerta S. Predictors of early mortality in veteran patients with pancreatic cancer. Am J Surg. 2007;194(3):362-6.
- 15. Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutrition journal. 2010;9:69.
- 16. Chen Z, Shao Y, Yao H, Zhuang Q, Wang K, Xing Z, et al. Preoperative albumin to globulin ratio predicts survival in clear cell renal cell carcinoma patients. Oncotarget. 2017;8(29):48291-302.
- 17. Xiao S, Feng F, Liu N, Liu Z, Guo Y, Lian X, et al. Preoperative Albumin Level Is Superior To Albumin-Globulin Ratio As A Predicting Indicator In Gastric Cancer Patients Who Underwent Curative Resection. Cancer Manag Res. 2019;11:9931-8.
- 18. Alkan A, Köksoy EB, Utkan G. Albumin to globulin ratio, a predictor or a misleader? Annals of oncology : official journal of the European Society for Medical Oncology. 2015;26(2):443-4.
- 19. Pfensig C, Dominik A, Borufka L, Hinz M, Stange J, Eggert M. A New Application for Albumin Dialysis in Extracorporeal Organ Support: Characterization of a Putative Interaction Between Human Albumin and Proinflammatory Cytokines IL-6 and TNFα. Artificial organs. 2016;40(4):397-402.
- 20. Azab B, Kedia S, Shah N, Vonfrolio S, Lu W, Naboush A, et al. The value of the pretreatment albumin/globulin ratio in predicting the long-term survival in colorectal cancer. Int J Colorectal Dis. 2013;28(12):1629-36.
- 21. Guo YZ, Pan L, Du CJ, Ren DQ, Xie XM. Association between C-reactive protein and risk of cancer: a meta-analysis of prospective cohort studies. Asian Pac J Cancer Prev. 2013;14(1):243-8.
- 22. Kristal AR, Schenk JM, Song Y, Arnold KB, Neuhouser ML, Goodman PJ, et al. Serum steroid and sex hormone-binding globulin concentrations and the risk of incident benign prostatic hyperplasia: results from the prostate cancer prevention trial. Am J Epidemiol. 2008;168(12):1416-24.
- 23. Huang R, Ma Y, Holm R, Trope CG, Nesland JM, Suo Z. Sex hormone-binding globulin (SHBG) expression in ovarian carcinomas and its clinicopathological associations. PLoS One. 2013;8(12):e83238.
- 24. Chen J, Zhou Y, Xu Y, Zhu HY, Shi YQ. Low pretreatment serum globulin may predict favorable prognosis for gastric cancer patients. Tumour Biol. 2016;37(3):3905-11.
- 25. Liu J, Chen S, Geng Q, Liu X, Kong P, Zhan Y, et al. Prognostic value of pretreatment albumin-globulin ratio in predicting long-term mortality in gastric cancer patients who underwent D2 resection. OncoTargets and therapy. 2017;10:2155-62.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 7 Haziran 2021 |
| Kabul Tarihi | 5 Nisan 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 13 Sayı: 2 |
