The prognostic value of serum albumin and hemoglobin in patients with proximal gastric cancer

Objective To evaluate serum albumin (ALB) combined with hemoglobin (Hb) (ALB-Hb) in the prediction of prognosis of patients with proximal gastric cancer. Methods Clinial data of 311 patients with stage Ⅰ-Ⅲ proximal gastric cancer who underwent radical surgery were retrospectively analyzed in Harbin Medical University Cancer Hospital from Sep 2001 to Nov 2014 . The preoperative ALB-Hb was calculated as following: patients with both elevated serum albumin (≥40.25 g/L) and hemoglobin (≥120 in male or ≥110 g/L infemale) were given a score of 0, and patients with only one or none were given a score of 1 or 2, respectively. The ALB-HB scores of 0 points had 175 cases (56.2%), 1 point had 87 cases (28.0%), and 2 points had 49 cases (15.8%). The optimal cut-off value of serum albumin, platelet count and maximum tumor diameter were defined by ROC curve; Pearson correlation was used to evaluate the correlation coefficient between serum albumin and HB; Survival analysis was analyzed by Kaplan-Meier method.The prognostic factors for patients with proximal gastric cancer was analyzed by COX proportional hazards model.The ROC curve was used to compare the prognostic value of serum albumin, hemoglobin, and ALB-Hb. Results Patients with ALB-Hb score of 2 were associated with age, serum platelet level, and maximum tumor diameter (all P<0.05). The median survival time was 41 months (3-134 months). 233 cases (74.9%) died and 78 cases (25.1%) survived as of Jan 2018.There was a significant difference in overall survival (OS) among AlB-Hb scores of 0, 1, and 2 (P=0.011). Univariate analysis demonstrated that platelet count, ALB-Hb score, maximum tumor diameter, and clinical stage were related to the prognosis of patients with proximal gastric cancer (all P<0.05). By multivariate analysis there were statistically significant differences in pathological parameters: ALB-Hb score (HR=1.249, 95% CI 1.047-1.489, P=0.013), maximum tumor diameter (HR=1.352, 95% CI 1.016-1.799, P=0.038) and TNM clinical stage (HR=1.667 95% CI 1.266-2.194, P<0.001) is an independent risk factor for prognosis. ALB-Hb score compared to serum albumin and hemoglobin alone, has a higher AUC value (P=0.019). Conclusions The preoperative ALB-Hb score is superior to serum albumin or hemoglobin alone in assessing the prognosis for patients with stage Ⅰ, Ⅱ, and Ⅲ proximal gastric cancer. Key words: Stomach neoplasms; Serum albumin; Hemoglobins; Prognosis