Prediction of three lipid derivatives for postoperative gastric cancer mortality: the Fujian prospective investigation of cancer (FIESTA) study

As we previously reported, the presence of preoperative metabolic syndrome can predict the significant risk of gastric cancer mortality. As a further extension, we evaluated the prediction of three lipid derivatives generated from triglycerides (TG), total cholesterol (TC), high- and low-density lip...

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Published inBMC cancer Vol. 18; no. 1; pp. 785 - 12
Main Authors Hu, Dan, Peng, Feng, Lin, Xiandong, Chen, Gang, Liang, Binying, Chen, Ying, Li, Chao, Zhang, Hejun, Fan, Guohui, Xu, Guodong, Xia, Yan, Lin, Jinxiu, Zheng, Xiongwei, Niu, Wenquan
Format Journal Article
LanguageEnglish
Published England BioMed Central Ltd 06.08.2018
BioMed Central
BMC
Subjects
Aged
Biomarkers, Tumor - blood
Cancer therapies
Care and treatment
China - epidemiology
Cholesterol
Cholesterol - blood
Cholesterol, HDL - blood
Cholesterol, LDL - blood
Decision Support Techniques
Female
Gastrectomy
Gastrectomy - adverse effects
Gastrectomy - mortality
Gastric cancer
Hospitals
Humans
Hypertension
Lipid derivative
Lipids
Low density lipoprotein
Male
Medical prognosis
Metabolic syndrome
Metastasis
Middle Aged
Mortality
Nomograms
Patient outcomes
Patients
Predictive Value of Tests
Prognosis
Prospective Studies
Risk Assessment
Risk Factors
Stomach cancer
Stomach Neoplasms - blood
Stomach Neoplasms - mortality
Stomach Neoplasms - pathology
Stomach Neoplasms - surgery
Surgical outcomes
Survival analysis
The FIESTA study
Thoracic surgery
Time Factors
Treatment Outcome
Triglycerides - blood
Tumors
China
The FIESTA study
Lipid derivative
Prognosis
Metabolic syndrome
Gastric cancer
Mortality
Online AccessGet full text

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Abstract As we previously reported, the presence of preoperative metabolic syndrome can predict the significant risk of gastric cancer mortality. As a further extension, we evaluated the prediction of three lipid derivatives generated from triglycerides (TG), total cholesterol (TC), high- and low-density lipoprotein cholesterol (HDLC and LDLC) at baseline for postoperative gastric cancer mortality by prospectively analysing 3012 patients. The three lipid derivatives included the ratio of TC minus HDLC to HDLC known as atherogenic index (AI), the ratio of TG to HDLC abbreviated as THR and the ratio of LDLC to HDLC abbreviated as LHR. Gastric cancer patients who received gastrectomy between January 2000 and December 2010 were consecutively recruited from Fujian Cancer Hospital. Follow-up assessment was implemented annually before December 2015. Finally, there were 1331 deaths from gastric cancer and 1681 survivors, with a median follow-up time of 44.05 months. 3012 patients were evenly randomized into the derivation group and the validation group, and both groups were well balanced at baseline. Overall adjusted estimates in the derivation group were statistically significant for three lipid derivatives (hazard ratio [HR]: 1.20, 1.17 and 1.19 for AI, THR and LHR, respectively, all P < 0.001), and were reproducible in the validation group. The risk prediction of three lipid derivatives was more obvious in males than females, in patients with tumor-node-metastasis stage I-II than stage III-IV, in patients with intestinal-type than diffuse-type gastric cancer, in patients with normal weight than obesity, and in patients without hypertension than with hypertension, especially for AI and LHR, and all results were reproducible. Calibration and discrimination statistics showed good reclassification performance and predictive accuracy when separately adding three lipid derivatives to baseline risk model. A prognostic nomogram was accordingly built based on significant attributes to facilitate risk assessment, with a good prediction capability. Our results indicate that preoperative lipid derivatives, especially AI and LHR, are powerful predictors of postoperative gastric cancer mortality, with more obvious prediction in patients of male gender or with tumor-node-metastasis stage I-II or intestinal-type gastric cancer, and in the absence of obesity or hypertension before gastrectomy.
AbstractList Background As we previously reported, the presence of preoperative metabolic syndrome can predict the significant risk of gastric cancer mortality. As a further extension, we evaluated the prediction of three lipid derivatives generated from triglycerides (TG), total cholesterol (TC), high- and low-density lipoprotein cholesterol (HDLC and LDLC) at baseline for postoperative gastric cancer mortality by prospectively analysing 3012 patients. The three lipid derivatives included the ratio of TC minus HDLC to HDLC known as atherogenic index (AI), the ratio of TG to HDLC abbreviated as THR and the ratio of LDLC to HDLC abbreviated as LHR. Methods Gastric cancer patients who received gastrectomy between January 2000 and December 2010 were consecutively recruited from Fujian Cancer Hospital. Follow-up assessment was implemented annually before December 2015. Results Finally, there were 1331 deaths from gastric cancer and 1681 survivors, with a median follow-up time of 44.05 months. 3012 patients were evenly randomized into the derivation group and the validation group, and both groups were well balanced at baseline. Overall adjusted estimates in the derivation group were statistically significant for three lipid derivatives (hazard ratio [HR]: 1.20, 1.17 and 1.19 for AI, THR and LHR, respectively, all P < 0.001), and were reproducible in the validation group. The risk prediction of three lipid derivatives was more obvious in males than females, in patients with tumor-node-metastasis stage I-II than stage III-IV, in patients with intestinal-type than diffuse-type gastric cancer, in patients with normal weight than obesity, and in patients without hypertension than with hypertension, especially for AI and LHR, and all results were reproducible. Calibration and discrimination statistics showed good reclassification performance and predictive accuracy when separately adding three lipid derivatives to baseline risk model. A prognostic nomogram was accordingly built based on significant attributes to facilitate risk assessment, with a good prediction capability. Conclusions Our results indicate that preoperative lipid derivatives, especially AI and LHR, are powerful predictors of postoperative gastric cancer mortality, with more obvious prediction in patients of male gender or with tumor-node-metastasis stage I-II or intestinal-type gastric cancer, and in the absence of obesity or hypertension before gastrectomy. Keywords: The FIESTA study, Gastric cancer, Lipid derivative, Metabolic syndrome, Mortality, Prognosis
As we previously reported, the presence of preoperative metabolic syndrome can predict the significant risk of gastric cancer mortality. As a further extension, we evaluated the prediction of three lipid derivatives generated from triglycerides (TG), total cholesterol (TC), high- and low-density lipoprotein cholesterol (HDLC and LDLC) at baseline for postoperative gastric cancer mortality by prospectively analysing 3012 patients. The three lipid derivatives included the ratio of TC minus HDLC to HDLC known as atherogenic index (AI), the ratio of TG to HDLC abbreviated as THR and the ratio of LDLC to HDLC abbreviated as LHR.BACKGROUNDAs we previously reported, the presence of preoperative metabolic syndrome can predict the significant risk of gastric cancer mortality. As a further extension, we evaluated the prediction of three lipid derivatives generated from triglycerides (TG), total cholesterol (TC), high- and low-density lipoprotein cholesterol (HDLC and LDLC) at baseline for postoperative gastric cancer mortality by prospectively analysing 3012 patients. The three lipid derivatives included the ratio of TC minus HDLC to HDLC known as atherogenic index (AI), the ratio of TG to HDLC abbreviated as THR and the ratio of LDLC to HDLC abbreviated as LHR.Gastric cancer patients who received gastrectomy between January 2000 and December 2010 were consecutively recruited from Fujian Cancer Hospital. Follow-up assessment was implemented annually before December 2015.METHODSGastric cancer patients who received gastrectomy between January 2000 and December 2010 were consecutively recruited from Fujian Cancer Hospital. Follow-up assessment was implemented annually before December 2015.Finally, there were 1331 deaths from gastric cancer and 1681 survivors, with a median follow-up time of 44.05 months. 3012 patients were evenly randomized into the derivation group and the validation group, and both groups were well balanced at baseline. Overall adjusted estimates in the derivation group were statistically significant for three lipid derivatives (hazard ratio [HR]: 1.20, 1.17 and 1.19 for AI, THR and LHR, respectively, all P < 0.001), and were reproducible in the validation group. The risk prediction of three lipid derivatives was more obvious in males than females, in patients with tumor-node-metastasis stage I-II than stage III-IV, in patients with intestinal-type than diffuse-type gastric cancer, in patients with normal weight than obesity, and in patients without hypertension than with hypertension, especially for AI and LHR, and all results were reproducible. Calibration and discrimination statistics showed good reclassification performance and predictive accuracy when separately adding three lipid derivatives to baseline risk model. A prognostic nomogram was accordingly built based on significant attributes to facilitate risk assessment, with a good prediction capability.RESULTSFinally, there were 1331 deaths from gastric cancer and 1681 survivors, with a median follow-up time of 44.05 months. 3012 patients were evenly randomized into the derivation group and the validation group, and both groups were well balanced at baseline. Overall adjusted estimates in the derivation group were statistically significant for three lipid derivatives (hazard ratio [HR]: 1.20, 1.17 and 1.19 for AI, THR and LHR, respectively, all P < 0.001), and were reproducible in the validation group. The risk prediction of three lipid derivatives was more obvious in males than females, in patients with tumor-node-metastasis stage I-II than stage III-IV, in patients with intestinal-type than diffuse-type gastric cancer, in patients with normal weight than obesity, and in patients without hypertension than with hypertension, especially for AI and LHR, and all results were reproducible. Calibration and discrimination statistics showed good reclassification performance and predictive accuracy when separately adding three lipid derivatives to baseline risk model. A prognostic nomogram was accordingly built based on significant attributes to facilitate risk assessment, with a good prediction capability.Our results indicate that preoperative lipid derivatives, especially AI and LHR, are powerful predictors of postoperative gastric cancer mortality, with more obvious prediction in patients of male gender or with tumor-node-metastasis stage I-II or intestinal-type gastric cancer, and in the absence of obesity or hypertension before gastrectomy.CONCLUSIONSOur results indicate that preoperative lipid derivatives, especially AI and LHR, are powerful predictors of postoperative gastric cancer mortality, with more obvious prediction in patients of male gender or with tumor-node-metastasis stage I-II or intestinal-type gastric cancer, and in the absence of obesity or hypertension before gastrectomy.
As we previously reported, the presence of preoperative metabolic syndrome can predict the significant risk of gastric cancer mortality. As a further extension, we evaluated the prediction of three lipid derivatives generated from triglycerides (TG), total cholesterol (TC), high- and low-density lipoprotein cholesterol (HDLC and LDLC) at baseline for postoperative gastric cancer mortality by prospectively analysing 3012 patients. The three lipid derivatives included the ratio of TC minus HDLC to HDLC known as atherogenic index (AI), the ratio of TG to HDLC abbreviated as THR and the ratio of LDLC to HDLC abbreviated as LHR. Gastric cancer patients who received gastrectomy between January 2000 and December 2010 were consecutively recruited from Fujian Cancer Hospital. Follow-up assessment was implemented annually before December 2015. Finally, there were 1331 deaths from gastric cancer and 1681 survivors, with a median follow-up time of 44.05 months. 3012 patients were evenly randomized into the derivation group and the validation group, and both groups were well balanced at baseline. Overall adjusted estimates in the derivation group were statistically significant for three lipid derivatives (hazard ratio [HR]: 1.20, 1.17 and 1.19 for AI, THR and LHR, respectively, all P < 0.001), and were reproducible in the validation group. The risk prediction of three lipid derivatives was more obvious in males than females, in patients with tumor-node-metastasis stage I-II than stage III-IV, in patients with intestinal-type than diffuse-type gastric cancer, in patients with normal weight than obesity, and in patients without hypertension than with hypertension, especially for AI and LHR, and all results were reproducible. Calibration and discrimination statistics showed good reclassification performance and predictive accuracy when separately adding three lipid derivatives to baseline risk model. A prognostic nomogram was accordingly built based on significant attributes to facilitate risk assessment, with a good prediction capability. Our results indicate that preoperative lipid derivatives, especially AI and LHR, are powerful predictors of postoperative gastric cancer mortality, with more obvious prediction in patients of male gender or with tumor-node-metastasis stage I-II or intestinal-type gastric cancer, and in the absence of obesity or hypertension before gastrectomy.
As we previously reported, the presence of preoperative metabolic syndrome can predict the significant risk of gastric cancer mortality. As a further extension, we evaluated the prediction of three lipid derivatives generated from triglycerides (TG), total cholesterol (TC), high- and low-density lipoprotein cholesterol (HDLC and LDLC) at baseline for postoperative gastric cancer mortality by prospectively analysing 3012 patients. The three lipid derivatives included the ratio of TC minus HDLC to HDLC known as atherogenic index (AI), the ratio of TG to HDLC abbreviated as THR and the ratio of LDLC to HDLC abbreviated as LHR. Gastric cancer patients who received gastrectomy between January 2000 and December 2010 were consecutively recruited from Fujian Cancer Hospital. Follow-up assessment was implemented annually before December 2015. Finally, there were 1331 deaths from gastric cancer and 1681 survivors, with a median follow-up time of 44.05 months. 3012 patients were evenly randomized into the derivation group and the validation group, and both groups were well balanced at baseline. Overall adjusted estimates in the derivation group were statistically significant for three lipid derivatives (hazard ratio [HR]: 1.20, 1.17 and 1.19 for AI, THR and LHR, respectively, all P < 0.001), and were reproducible in the validation group. The risk prediction of three lipid derivatives was more obvious in males than females, in patients with tumor-node-metastasis stage I-II than stage III-IV, in patients with intestinal-type than diffuse-type gastric cancer, in patients with normal weight than obesity, and in patients without hypertension than with hypertension, especially for AI and LHR, and all results were reproducible. Calibration and discrimination statistics showed good reclassification performance and predictive accuracy when separately adding three lipid derivatives to baseline risk model. A prognostic nomogram was accordingly built based on significant attributes to facilitate risk assessment, with a good prediction capability. Our results indicate that preoperative lipid derivatives, especially AI and LHR, are powerful predictors of postoperative gastric cancer mortality, with more obvious prediction in patients of male gender or with tumor-node-metastasis stage I-II or intestinal-type gastric cancer, and in the absence of obesity or hypertension before gastrectomy.
Abstract Background As we previously reported, the presence of preoperative metabolic syndrome can predict the significant risk of gastric cancer mortality. As a further extension, we evaluated the prediction of three lipid derivatives generated from triglycerides (TG), total cholesterol (TC), high- and low-density lipoprotein cholesterol (HDLC and LDLC) at baseline for postoperative gastric cancer mortality by prospectively analysing 3012 patients. The three lipid derivatives included the ratio of TC minus HDLC to HDLC known as atherogenic index (AI), the ratio of TG to HDLC abbreviated as THR and the ratio of LDLC to HDLC abbreviated as LHR. Methods Gastric cancer patients who received gastrectomy between January 2000 and December 2010 were consecutively recruited from Fujian Cancer Hospital. Follow-up assessment was implemented annually before December 2015. Results Finally, there were 1331 deaths from gastric cancer and 1681 survivors, with a median follow-up time of 44.05 months. 3012 patients were evenly randomized into the derivation group and the validation group, and both groups were well balanced at baseline. Overall adjusted estimates in the derivation group were statistically significant for three lipid derivatives (hazard ratio [HR]: 1.20, 1.17 and 1.19 for AI, THR and LHR, respectively, all P < 0.001), and were reproducible in the validation group. The risk prediction of three lipid derivatives was more obvious in males than females, in patients with tumor-node-metastasis stage I-II than stage III-IV, in patients with intestinal-type than diffuse-type gastric cancer, in patients with normal weight than obesity, and in patients without hypertension than with hypertension, especially for AI and LHR, and all results were reproducible. Calibration and discrimination statistics showed good reclassification performance and predictive accuracy when separately adding three lipid derivatives to baseline risk model. A prognostic nomogram was accordingly built based on significant attributes to facilitate risk assessment, with a good prediction capability. Conclusions Our results indicate that preoperative lipid derivatives, especially AI and LHR, are powerful predictors of postoperative gastric cancer mortality, with more obvious prediction in patients of male gender or with tumor-node-metastasis stage I-II or intestinal-type gastric cancer, and in the absence of obesity or hypertension before gastrectomy.
[...]a prognostic nomogram displaying 3-year, 5-year and 10-year gastric cancer mortality was constructed for clinical application among all study patients. 1.12–1.44, < 0.001 1.29, 1.11–1.51, 0.001 1.42, 1.20–1.66, < 0.001 1.21, 1.11–1.32, < 0.001 1.34, 1.14–1.58, < 0.001 Diffuse type 1.19, 1.12–1.27, < 0.001 1.16, 1.07–1.26, < 0.001 1.17, 1.10–1.24, 0.001 1.13, 1.04–1.22, 0.003 1.12, 1.05–1.23, 0.003 1.16, 1.06–1.27, 0.001 Tumor embolus Positive 1.23, 1.13–1.35, < 0.001 1.23, 1.14–1.33, < 0.001 1.28, 1.15–1.42, < 0.001 1.29, 1.15–1.44, < 0.001 1.16, 1.04–1.28, 0.006 1.27, 1.13–1.43, < 0.001 Negative 1.17, 1.09–1.26, < 0.001 1.11, 1.03–1.21, 0.011 1.16, 1.08–1.23, < 0.001 1.25, 1.12–1.40, < 0.001 1.16, 1.06–1.28, 0.002 1.22, 1.09–1.37, 0.001 Obesity With 1.11, 1.04–1.19, 0.031 1.13, 1.03–1.24, 0.012 1.09, 1.00–1.19, 0.051 1.12, 1.01–1.22, 0.042 1.07, 0.95–1.20, 0.276 1.07, 0.91–1.26, 0.399 Without 1.26, 1.10–1.43, 0.001 1.18, 1.10–1.26, < 0.001 1.24, 1.09–1.40, 0.001 1.31, 1.20–1.43, < 0.001 1.21, 1.11–1.32, < 0.001 1.30, 1.18–1.42, < 0.001 Hypertension With 1.07, 0.94–1.22, 0.338 1.05, 0.92–1.19, 0.502 1.08, 0.94–1.24, 0.271 1.17, 1.01–1.35, 0.037 1.14, 1.00–1.29, 0.045 1.15, 0.98–1.35, 0.096 Without 1.22, 1.15–1.30, < 0.001 1.21, 1.14–1.28, < 0.001 1.21, 1.14–1.28, < 0.001 1.30, 1.18–1.42, < 0.001 1.16, 1.07–1.26, 0.001 1.27, 1.16–1.39, < 0.001 Diabetes With 1.13, 1.04–1.22, 0.004 1.08, 1.02–1.16, 0.013 1.14, 1.05–1.25, 0.001 1.17, 1.08–1.28, 0.002 1.07, 0.98–1.16, 0.106 1.18, 1.08–1.29, < 0.001 Without 1.18, 1.07–1.29, 0.001 1.16, 0.98–1.36, 0.080 1.15, 1.06–1.26, 0.001 1.21, 1.08–1.36, < 0.001 1.20, 1.05–1.38, 0.010 1.20, 1.09–1.30, < 0.001 Data are expressed as hazard ratio, 95% confidence interval, P value. Besides unadjusted overall estimates, the other risk estimates were calculated after adjusting for age, gender, smoking, drinking, family cancer history, body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, TNM stage, tumor size, Lauren’s classification, number of lymph node metastasis and tumor embolus by removing the characteristic itself in stratified analysis Abbreviations: AI atherogenic index, THR the triglyceride to high-density lipoprotein cholesterol ratio, LHR the low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio, TNM tumor-node-metastasis By gender, the risk prediction of three lipid derivatives was markedly corroborated in male patients compared with female patients in both derivation and validation groups, especially for AI (HR, 95% CI, P: 1.27, 1.17–1.38, < 0.001 in the derivation group and 1.30, 1.18–1.43, < 0.001 in the validation group) and LHR (1.25, 1.15–1.36, < 0.001 in the derivation group and 1.26, 1.16–1.38, < 0.001 in the validation group). [...]our findings can be easily applied for risk assessment in routine clinical practice. [...]the effects of lipid-lowering agents on the prognosis of gastric cancer patients remained unexplored, as such data were currently lacking, which might generate a systematic bias and unaccounted residual confounding.
ArticleNumber 785
Audience Academic
Author Zhang, Hejun
Niu, Wenquan
Chen, Ying
Lin, Xiandong
Fan, Guohui
Liang, Binying
Hu, Dan
Lin, Jinxiu
Peng, Feng
Xia, Yan
Chen, Gang
Xu, Guodong
Li, Chao
Zheng, Xiongwei
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/30081869$$D View this record in MEDLINE/PubMed
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Issue 1
Keywords The FIESTA study
Lipid derivative
Prognosis
Metabolic syndrome
Gastric cancer
Mortality
Language English
License Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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Snippet As we previously reported, the presence of preoperative metabolic syndrome can predict the significant risk of gastric cancer mortality. As a further...
Background As we previously reported, the presence of preoperative metabolic syndrome can predict the significant risk of gastric cancer mortality. As a...
[...]a prognostic nomogram displaying 3-year, 5-year and 10-year gastric cancer mortality was constructed for clinical application among all study patients....
Abstract Background As we previously reported, the presence of preoperative metabolic syndrome can predict the significant risk of gastric cancer mortality. As...
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SubjectTerms Aged
Biomarkers, Tumor - blood
Cancer therapies
Care and treatment
China - epidemiology
Cholesterol
Cholesterol - blood
Cholesterol, HDL - blood
Cholesterol, LDL - blood
Decision Support Techniques
Female
Gastrectomy
Gastrectomy - adverse effects
Gastrectomy - mortality
Gastric cancer
Hospitals
Humans
Hypertension
Lipid derivative
Lipids
Low density lipoprotein
Male
Medical prognosis
Metabolic syndrome
Metastasis
Middle Aged
Mortality
Nomograms
Patient outcomes
Patients
Predictive Value of Tests
Prognosis
Prospective Studies
Risk Assessment
Risk Factors
Stomach cancer
Stomach Neoplasms - blood
Stomach Neoplasms - mortality
Stomach Neoplasms - pathology
Stomach Neoplasms - surgery
Surgical outcomes
Survival analysis
The FIESTA study
Thoracic surgery
Time Factors
Treatment Outcome
Triglycerides - blood
Tumors
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Title Prediction of three lipid derivatives for postoperative gastric cancer mortality: the Fujian prospective investigation of cancer (FIESTA) study
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