Preoperative albumin-to-CEA ratio predicts survival in gastric cancer after gastrectomy
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Key Takeaway
Consider preoperative ACR as a potential prognostic marker in gastric cancer, pending prospective validation.
This retrospective cohort study analyzed 1,161 gastric cancer patients who underwent radical gastrectomy at Shanxi Province Cancer Hospital between December 2015 and January 2017. The study examined the association between preoperative albumin-to-carcinoembryonic antigen ratio (ACR) and survival outcomes, comparing the predictive value of an ACR-based nomogram against the conventional TNM staging system.
Patients with low ACR (192 patients, 16.5%) had significantly shorter overall survival (HR=0.741, 95% CI: 0.606–0.906; P=0.003) and disease-free survival (HR=0.809, 95% CI: 0.655–0.998; P=0.048) compared to those with high ACR (969 patients, 83.5%). The ACR-based nomogram demonstrated superior predictive accuracy with C-index values of 0.748 for overall survival and 0.730 for disease-free survival, outperforming the TNM staging system.
Safety and tolerability data were not reported. Key limitations include the retrospective, single-center design and lack of reported follow-up duration. The study population was limited to one hospital in Shanxi Province, which may affect generalizability. Funding sources and conflicts of interest were not reported.
While the authors suggest the ACR-based nomogram could serve as a clinically useful tool for prognostic prediction and risk stratification, these findings require prospective validation in diverse populations before clinical implementation. The observational nature of the study precludes causal conclusions about ACR's role in survival outcomes.
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View Original Abstract ↓
AimThis study aimed to evaluate the association between the preoperative albumin-to-carcinoembryonic antigen ratio (ACR) and clinicopathological characteristics as well as the association between ACR and prognosis in gastric cancer, so as to provide evidence for improved risk stratification and personalized management.MethodsClinicopathological data of gastric cancer patients who underwent radical gastrectomy at Shanxi Province Cancer Hospital between December 2015 and January 2017 were retrospectively reviewed. Following patient follow-up, Cox proportional-hazards regression was used to identify prognostic factors for overall survival (OS) and disease-free survival (DFS). An ACR-incorporated nomogram was developed, and its predictive accuracy was evaluated using the concordance index (C-index) and calibration curves. Its discriminative ability was further compared against that of the conventional TNM staging system.ResultsAmong the 1,161 enrolled patients, 192 (16.5%) and 969 (83.5%) were classified into low- and high-ACR groups, respectively. Low ACR was correlated with adverse pathological features and inferior survival outcomes. Both OS and DFS were significantly shorter in the low-ACR group (both P < 0.001). Multivariate analysis identified high ACR as an independent protective factor for OS (HR = 0.741, 95% CI: 0.606–0.906; P = 0.003) and DFS (HR = 0.809, 95% CI: 0.655–0.998; P = 0.048). Time-dependent receiver operating characteristic (ROC) analysis confirmed the good predictive performance of the ACR-based model in both training and validation sets. The nomogram demonstrated superior predictive accuracy (C-index: 0.748 for OS, 0.730 for DFS) compared with the TNM staging system.ConclusionPreoperative low ACR is significantly associated with aggressive tumor biology and poor survival in gastric cancer. The ACR-based nomogram serves as a clinically useful tool for prognostic prediction, risk stratification, and the guidance of personalized therapy.
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