Study On CRP/Alb Ratio And Gps Score In Evaluating Preoperative Biological Behavior Of Gastric Cancer

Objective: By detecting the level of preoperative serum CRP and Alb in patients with gastric cancer,we explored the correlation between preoperative serum CRP/Alb ratio and Glasgow prognosis score with the clinicopathological parameters,including tumor site,tumor size,Lauren classification,differentiation,neural and vascular invasion,TNM stage and clinical pathological stage of gastric cancer patients.to Explore the biological behavior of gastric cancer according to the preoperative serum CRP/Alb ratio and GPS scores and provide experimental basis for preoperative assessment of biological behavior of gastric cancer.Methods: One hundred and twenty-one patients with gastric cancer undergoing curative resection of gastric cancer from December 2016 to August 2017 were selected as the experimental group and selected 60 cases of physical examination in our hospital in the same periodas as control group.Collectting serum from patients with gastric cancer preoperatively and healthy volunteers and then measuring the CRP and Alb levels by immunonephelometry and bromocresol green method respectively.CAR and GPS were calculated and grouped according to CAR median and GPS score(including high CAR group,low CAR group and GPS0 pgroup,GPS1 group and GPS2 group),and performed statistical analysis on the relationship between the expression of CAR and GPS in different groups with the clinicopathological parameters of gastric cancer.Besides,selected 10 patients with gastric cancer which were hospitalized in the Department of Gastrointestinal Surgery of the First Hospital of Ji Lin universityrandomly from January 2018 to February 2018 and undergoing radical gastrectomy for gastric cancer and defined them as the verification group and measured serum CRP and Alb level before surgery.According to the results of the population analysis,the preoperative prediction of the biological behavior of gastric cancer was performed.By comparing with the postoperative pathological results,it was further verified whether preoperative serum CAR and GPS can accurately predict the biological behavior of gastric cancer before surgery.Results: 1.Preoperative CRP level was significantly higher in gastric cancer patients compared with healthy subjects(P<0.05),the preoperative Alb level in gastric cancer patientswas significantly lower than that in healthy subjects(P<0.01),and the preoperative CAR level in gastric cancer patientswas significantly higher than that in the healthy subjects(P<0.01).2.There were significant differences in age,tumor diameter,infiltration of blood vessel and nerve,T stage,N stage,Lauren classification,tumor progression and clinicopathological stage between high-CAR group and low-CAR group(all P<0.05).The number of patients whose tumor diameter ≥2 cm and with infiltration of blood vessel and nerve were significantly higher than those in the low-CAR group(all P <0.05).3.The preoperative CAR levels in patients whose tumor size > 2cm and with the occurrence of nerve,vascular invasion were higher than their opposition groups(P<0.05).The preoperative levels of CAR in patients with Ⅲ and Ⅳ clinical stage was higher than those of I and II stage.Preoperative levels of CAR were higher in patients with T3 and T4 stage than those of T1 and T2 stage.Preoperative levels of CAR in patients with N1~N3 stage were significantly higher than those in stage N0.preoperative serum CAR levels in patients with advanced gastric cancer were higher than those in early gastric cancer patients(all P<0.05).There were significant differences in preoperative CAR levels among patients with different Lauren types(all P<0.05)and preoperative serum CAR level in patients with mixed gastric cancer wase significantly higher than that in intestinal patients(P<0.05).4.The rate and degree of lymph node metastasis in high CAR group(81.5% and 28.8% respectively)were significantly higher than those in low CAR group(51.8% and 13.3% respectively)(P<0.01).5.Different levels of preoperative GPS among patients with gastric were different significantly in tumor progression,vascular invasion and T-stage(P<0.05).6.The degree of lymph node metastasis in GPS2 group was higher than that in GPS0 group and GPS1 group(GPS1 vs GPS0: P>0.05,GPS2 vs GPS0: P<0.001, GPS2 vs GPS1:P<0.001).7.The differences of the rate and degree of lymph node metastasis between high CAR group and GPS1 group were statistically significant(metastasis rate: P<0.05,degree of metastasis : P<0.001).There was significant difference in the degree of lymph node metastasis between GPS0 group and GPS0 group(P<0.05).8.Among the 10 patients with gastric cancer in the verification group,7 patients with high CAR value and GPS2 had a maximum tumor diameter of ≥3cm,among which 4 patients had a tumor whose maximal diameter were>5cm;there were 6 patients whose tissures were infiltrated into the serosa or subserosa and only one case infiltrated into the muscularis propria.As for another 3 patients with low CAR value and GPS0 score,there maximum diameter of tumor was all less than 5cm.Conclusions: 1.Preoperative serum CAR value > 0.08 indicates that the diameter of gastric cancer is larger,the depth of invasion is deeper,and their are more lymph node metastasis,which is helpful for evaluating the biological behavior of gastric cancer before operation.2.Patients with GPS score of 2 preoperatively were more prone to vascular invasion and lymph node metastasis than the scpre of 0 and 1.3.The validation results shows that the preoperative CAR value and GPS score were stable in evaluating the tumor diameter,TNM stage,clinical progress,and lymph node metastasis of gastric cancer,while the value of CAR and GPS on the assessment of neural invasion and tumor progression is still waiting for further verification.