Blood parameters score predicts long-term outcomes in stage Ⅱ-Ⅲ gastric cancer patients

BACKGROUND Increasing numbers of laboratory blood parameters(BPM) have been reported to greatly affect the long-term outcomes of gastric cancer(GC) patients. However,the existing prognostic models do not comprehensively analyze these predictors.AIM To construct a new prognostic tool, based on all the prognostic BPM, to achieve more accurate prognosis prediction for GC.METHODS We retrospectively assessed 850 consecutive patients who underwent curative resection for stage II-III GC from January 2010 to April 2013. The patients were classified into developing(n = 567) and validation(n = 283) cohorts using computer-generated random numbers. A scoring system, namely BPM score, was then constructed using least absolute shrinkage and selection operator(LASSO)Cox regression model in the developing cohort, and validated in the validation cohort. A nomogram consisting of BPM score and tumor-lymph node-metastasis(TNM) stage was further created. The discrimination and calibration of the nomogram were evaluated via Harrell’s C-statistic and the Hosmer-Lemeshow test.RESULTS Using the LASSO model, we established the BPM score based on five BPM:Albumin, lymphocyte-to-monocyte ratio, neutrophil-to-lymphocyte ratio,carcinoembryonic antigen, and carbohydrate antigen 19-9. The BPM scores were divided into high-and low-BPM groups based on a cut-off value of-0.93. HighBPM patients were significantly older and had more advanced, larger tumors. In the developing cohort, significant differences were found in 5-year overall survival(OS) and 5-year disease-specific survival between the high-BPM and low-BPM patients. Similar results were found in the validation group.Multivariable analysis showed that the BPM score was an independent predictor of OS. High-BPM patients had a poorer 5-year OS for each subgroup.Furthermore, a nomogram that combined the BPM score and TNM stage had significantly better prognostic value compared with TNM stage alone.CONCLUSION The BPM score provides more accurate prognosis prediction in stage II-III GC patients and is an effective complement to the TNM staging system.