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

Abstract

PurposeTo characterize clinical features and identify baseline prognostic factors for survival in young adults with advanced gastric cancer (YAAGC).Materials and MethodsA 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.ResultsOf 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.ConclusionsThree 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.

Latin American young patients with gastric adenocarcinoma: worst prognosis and outcomes

“…In the present study, GC diagnosis is slightly more frequent in women with a ratio of 1:1.1 (men: women). Chen et al , reported that ratio distribution is modified according primary tumor location, such as distal location (2:1) and proximal (5:1) male: female ( 12 ). In our analysis the ratio was 1:1.2 (male: female) in distal gastric cancer and 2.5:1 (male: female) in esophagogastric junction.…”

“…described that young population with GC showed a three-year OS of 6.9% ( 10 , 11 ). Other studies have also demonstrated that young populations with GC have lower progression free survival rates (P=0.012) ( 12 ), and higher cancer related mortality (P=0.048) ( 13 ), which can be explained by tumor location, ethnicity, tumor size, surgery, tumor, node, metastasis (TNM) stage, clinical stage of disease, poorly differentiated, signet cell type, and female gender prevalence ( 9 , 10 , 12 - 14 ).…”

“…On the other hand, studies revealed that younger patients showed better overall survival (OS) rates; 62.1% versus 28.1% for elderly patients ranging different races and TNM stage ( 14 - 16 ), Additionally several meta-analyses have associated young age with a better prognosis, favored by a good performance status, surgery and adjuvant chemotherapy ( 12 , 15 , 16 ). Moreover, other studies found no differences in survival rates between young and elderly patients ( 17 , 18 ).…”

Predicting central nervous system relapse in primary breast diffuse large B-cell lymphoma using the stage-modified IPI score: A retrospective cohort study

“…The informed consent was obtained from all subjects and/or their legal guardian(s). Demographic information, tumor characteristics, diagnostic test results, administered treatments, and clinical outcomes were extracted from electronic medical records, as previously described [ 12 , 13 ]. CNS relapse was confirmed through imaging and pathological studies or cytology of cerebrospinal fluid.…”

Clinical Characteristics and Prognostic Factors in Primary Breast Diffuse Large B-Cell Lymphoma

“…The association between demographic, clinical, or laboratory variables and the primary outcome (OS) were assessed using univariate Kaplan-Meier (KM) analysis (a stratified log-rank test) and multivariate Cox regression models as previously reported. 33 Briefly, the prognostic effect of each factor was analyzed by a log-rank test. Clinically relevant covariates ( p <0.15) identified in univariate analyses were included in multivariate models.…”