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Preoperative total cholesterol-lymphocyte score as a novel immunonutritional predictor of survival in gastric cancer

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Abstract

Purpose

Immunonutritional status is a known prognostic correlate in the context of gastric cancer (GC). In the present study, we investigated the prognostic relevance of a lipid profile-based immunonutritional score in patients with GC.

Methods

Data pertaining to 224 patients with stage II and III GC who underwent curative gastrectomy were retrospectively analyzed. The total cholesterol-lymphocyte score (TL score) was defined as follows: patients with both low total cholesterol (TC) and total lymphocyte count were allocated a score of 2; patients with only one or none of these biochemical abnormalities were allocated a score of 1 or 0, respectively.

Results

Among the serum lipid indices, low TC was the strongest predictor of cancer-specific survival (CSS; p = 0.001). On multivariate analysis, both low prognostic nutritional index (PNI) (p < 0.001) and high TL score (p = 0.003) were independent prognostic factors. PNI was significantly associated with peritoneal recurrence (p = 0.047), while TL score was significantly associated with locoregional and distant metastasis (p = 0.004 and p = 0.003, respectively).

Conclusions

TL score may facilitate risk stratification of patients based on CSS. TL score plus PNI may help predict the recurrence pattern in patients with stage II and III GC.

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Authors and Affiliations

  1. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto-shi, Kyoto, Japan

    Daiki Matsubara, Katsutoshi Shoda, Takeshi Kubota, Toshiyuki Kosuga, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Kazuma Okamoto, Michihiro Kudou, Tomohiro Arita, Ryo Morimura, Yasutoshi Murayama, Hisashi Ikoma, Yoshiaki Kuriu, Masayoshi Nakanishi & Eigo Otsuji

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  1. Daiki Matsubara
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Contributions

This study was designed by D.M., K.S., T.K., and E.O.; D.M. and K.S. performed statistical analyses. The clinical information and materials were collected and kept by K.S., T.K., T.K., H.K., A.S., H.F., K.O., T.A., M.K., R.M., Y.M., H.I., Y.K., and M.N.; D.M. and K.S. drafted the manuscript. T.K. edited and revised the manuscript. E.O. approved the final version of manuscript.

Corresponding author

Correspondence to Takeshi Kubota.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Matsubara, D., Shoda, K., Kubota, T. et al. Preoperative total cholesterol-lymphocyte score as a novel immunonutritional predictor of survival in gastric cancer. Langenbecks Arch Surg 404, 743–752 (2019). https://doi.org/10.1007/s00423-019-01824-8

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