Szor DJ, Pereira MA, Ramos MFKP, Tustumi F, Dias AR, Zilberstein B, Ribeiro Jr U. Preoperative albumin-bilirubin score is a prognostic factor for gastric cancer patients after curative gastrectomy. World J Gastrointest Surg 2023; 15(6): 1125-1137 [PMID: 37405095 DOI: 10.4240/wjgs.v15.i6.1125]
Corresponding Author of This Article
Daniel Jose Szor, MS, PhD, Postdoc, Professor, Surgeon, Surgical Oncologist, Department of Gastroenterology, Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 251 Av Dr Arnaldo, Sao Paulo 01246000, Brazil. danszor@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Table 2 Pathological characteristics of patients with gastric cancer according albumin-bilirubin groups, n (%)
Variables
Low-ALBI group (< -2.82), n = 211
High-ALBI group (≥ -2.82), n = 150
P value
Lauren type
0.367
Intestinal
124 (58.8)
81 (54.0)
Diffuse/mixed
87 (41.2)
69 (46.0)
Histological differentiation
0.993
Well/moderately differentiated
107 (59.7)
76 (50.7)
Poorly differentiated
104 (49.3)
74 (49.3)
Lymphatic invasion
0.132
No
121 (57.3)
74 (49.3)
Yes
90 (42.7)
76 (50.7)
Venous invasion
0.196
No
150 (71.1)
97 (64.7)
Yes
61 (28.9)
53 (35.3)
Perineural invasion
0.743
No
112 (53.1)
77 (51.3)
Yes
99 (46.9)
73 (48.7)
T status
0.105
pT1/T2
91 (43.1)
52 (34.7)
pT3/T4
120 (56.9)
98 (65.3)
No of dissected lymph nodes
0.543
mean (SD)
40.9 (17.7)
39.8 (17.2)
pN status
0.239
pN0
99 (46.9)
61 (40.7)
pN+
112 (53.1)
89 (59.3)
pTNM
0.222
I/II
122 (57.8)
77 (51.3)
III
89 (42.2)
73 (48.7)
Table 3 Postoperative and surgical outcomes of patients with gastric cancer according albumin-bilirubin groups, n (%)
Variables
Low-ALBI group (< -2.82), n = 211
High-ALBI group (≥ -2.82), n = 150
P value
Length of hospital stay (d)
0.673
Median (IQR)
9 (6.0-13.3)
10 (7.0-13.8)
Postoperative complications (Clavien)
0.029
Non/minor POC (I-II)
183 (86.7)
117 (78)
Major POC (III-IV)
28 (13.3)
33 (22)
Postoperative chemotherapy
0.917
No
117 (55.5)
84 (56)
Yes
94 (44.5)
66 (44)
Chemotherapy-all (pre or postoperative)
0.766
No
99 (46.9)
68 (45.3)
Yes
112 (53.1)
82 (54.7)
30-d motality
0.023
No
206 (97.6)
138 (92.6)
Yes
5 (2.4)
11 (7.4)
90-d motality
0.030
No
198 (94.7)
130 (88.4)
Yes
11 (5.3)
17 (11.6)
Table 4 Univariate and multivariate analysis for disease-free survival
Disease-free survival
Univariate
Multivariate
Variables
HR
95%CI
P value
HR
95%CI
P value
Male (vs female)
1.15
0.81-1.61
0.438
-
-
-
Age > 65 yr (vs < 65 yr)
1.18
0.86-1.62
0.312
-
-
-
Charlson > 1 (vs 0)
1.48
1.07-2.04
0.019
1.39
0.94-2.06
0.102
ASA III/IV (vs ASA I/II)
1.84
1.29-2.64
0.001
1.43
0.93-2.21
0.106
Total gastrectomy (vs distal)
1.43
1.04-1.97
0.030
1.43
1.03-1.98
0.031
Diffuse/mixed (vs others)
1.21
0.87-1.67
0.255
-
-
-
pT3/T4 (vs pT1/T2)
2.57
1.76-3.76
< 0.001
2.03
1.33-3.12
0.001
pN+ (vs pN0)
2.26
1.60-3.19
< 0.001
1.54
1.04-2.27
0.030
non-CMT (vs CMT)
1.15
0.83-1.58
0.399
-
-
-
Low-ALBI (vs High-ALBI)
2.09
1.51-2.88
< 0.001
1.83
1.32-2.53
< 0.001
Table 5 Univariate and multivariate analysis for overall survival
Overall survival
Univariate
Multivariate
Variables
HR
95%CI
P value
HR
95%CI
P value
Male (vs female)
1.20
0.85-1.71
0.306
-
-
-
Age > 65 yr (vs < 65 yr)
1.28
0.94-1.79
0.137
-
-
-
Charlson > 1 (vs 0)
1.42
1.02-1.98
0.041
1.25
0.83-1.89
0.282
ASA III/IV (vs ASA I/II)
1.94
1.35-2.80
< 0.001
1.60
1.02-2.52
0.041
Total gastrectomy (vs distal)
1.50
1.08-2.08
0.016
1.56
1.12-2.18
0.009
Diffuse/mixed (vs others)
1.29
0.93-1.79
0.133
-
-
-
pT3/T4 (vs pT1/T2)
2.44
1.65-3.61
< 0.001
1.87
1.20-2.91
0.006
pN+ (vs pN0)
2.24
1.57-3.20
< 0.001
1.58
1.06-2.37
0.026
non-CMT (vs CMT)
1.18
0.85-1.64
0.327
-
-
-
Low-ALBI (vs High-ALBI)
1.97
1.41-2.74
< 0.001
1.68
1.20-2.35
0.003
Citation: Szor DJ, Pereira MA, Ramos MFKP, Tustumi F, Dias AR, Zilberstein B, Ribeiro Jr U. Preoperative albumin-bilirubin score is a prognostic factor for gastric cancer patients after curative gastrectomy. World J Gastrointest Surg 2023; 15(6): 1125-1137