| Object:The clinicopathological data,hematological indices and their change values before and after neoadjuvant chemotherapy(NCT)of patients with gastric cancer(GC)were reviewed,and their correlation with the grading of tumor regression following neoadjuvant chemotherapy and the influence of the aforementioned indices on the survival of patient with gastric cancer were analyzed.Methods:Based on inclusion and exclusion criteria,120 patients with GC who underwent preoperative 2 to 5 NCT cycles at the Department of Surgical Oncology,First Hospital of Lanzhou University between December 2018 to July 2022 were chosen as the study population.The clinicopathological data,pretreatment(pre-)hematological indexes,posttreatment(post-)hematological indexes,and difference in hematological indices between pre-and post-indexes of neoadjuvant chemotherapy(△),and the tumor regression grade(TRG)criteria to determine the pathological efficacy of NCT,and the correlation of the above indicators with TRG was analyzed by spearman correlation analysis to screen out relevant effectiveness indicators.The long-term survival prognosis information of patients was followed up by electronic medical record system and telephone,and single and multifactorial analysis of overall survival(OS)was conducted by Kaplan-Meier survival analysis and proportional hazards regression with COX to clarify independent influential prognostic factors;on this basis,a prediction model based on the "column line graph" was constructed,and model differentiation and calibration was assessed by subjects ’area under the working characteristic curve(AUC)values of subjects and the Hosmer-Lemeshow test,and the clinical utility of the model was tested using the Decision Curve Analysis(DCA)software.Results: 1.The efficacy of NCT: 7(5.8%)in TRG 0,12(10%)in TRG 1,84(70%)in TRG 2,and 17(14.2%)in TRG 3;the effective(TRG 0+1+2)rate was 85.8% and the ineffective(TRG 3)rate was 14.7%.2.The correlates of TRG: Spearman analysis yielded pre-HDL(P=0.01),postHB(P=0.02),post-Plt(P<0.01),post-Alb(P<0.01),post-CHE(P<0.01),post-HDL P=0.04,and post-PNI(P < 0.01)had significant correlation with TRG.3.Prognostic influences: statistical analysis was performed using COX regression,first univariate analysis,and indicators with statistical differences(P < 0.05)were selected for inclusion in the multifactorial analysis,which revealed that BMI(P=0.008,HR=3.971,95% CI: 1.430-11.026),lymph node metastasis(P=0.009,HR=3.918,95% CI: 1.408-10.901),TTS(P <0.001,HR=10.168,95% CI: 3.230-32.009),Δ Alb(P=0.036,HR=3.352,95% CI:1.038-10.376),pre-HDL(P=0.028,HR=2.851,95% CI:1.118-7.269)were independent risk factors for OS.4.The independent risk factors for OS: BMI,lymph node metastasis,TTS,Δ Alb,and pre-HDL were used to construct a "line graph" prediction model using the R software,and the AUC values at 1 year and 3 years were 0.8(95% CI: 0.693-0.906)and 0.83(95% CI: 0.704-0.973),respectively.Hosmer-Lemeshow test results for 1 and 3 years showed that x~2=4.864,P=0.772>0.05;x~2=4.161,P=0.818>0.05;the model has good discriminatory and calibration ability,and the DCA curve suggest that the model has good clinical application ability.Conclusion: 1.pre-HDL,post-HB,post-Plt,post-Alb,post-CHE,post-HDL,and post-PNI were significantly correlated with tumor regression grade after neoadjuvant chemotherapy for gastric cancer.2.BMI,lymph node metastasis,TTS,△Alb and pre-HDL are independent risk factors for OS in patients with gastric cancer after NCT,and a model of "line graph" based on their specific values can be established predicted patients’ OS. |
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