br The American Joint Committee on Cancer
The American Joint Committee on Cancer (AJCC) TNM staging system has been recognized as the most important prognostic factor and the basis of treatment in GC. However, heterogeneities in the prognosis of individual patients with the same stage still exist.
Please cite this article as: Lin J-X et al., Association of the age-adjusted Charlson Comorbidity Index and systemic AWD 131-138 with survival in gastric cancer patients after radical gastrectomy, European Journal of Surgical Oncology, https://doi.org/10.1016/j.ejso.2019.07.010
J.-X. Lin et al. / European Journal of Surgical Oncology xxx (xxxx) xxx 7
In this study, a new prognostic model was established by combining the new ANLR maker and pTNM staging. Compared with the predictive accuracy of traditional TNM staging, the pre-dictive accuracy of the new model combining the ANLR with pTNM was significantly better, which suggested that the ANLR could improve the accuracy of prognosis assessment of GC. Therefore, in clinical practice, the ANLR can be used as a supplement for TNM staging in preoperative risk stratification to effectively guide the treatment strategy and postoperative follow-up of GC patients.
This study had some limitations. First, as a retrospective study, it is inevitable that there may be selection bias. Second, some un-avoidable confounding factors may exist in this study, such as ed-ucation level, diet or alcohol intake, which may affect the evaluation of the preoperative NLR and ACCI. Third, the consistency of the condition of the patients before preoperative blood drawing may not be guaranteed. Nevertheless, this study found that the ACCI is significantly related to the preoperative NLR in a large cohort. Based on these findings, we established a novel prognostic model, the ANLR. The ANLR combined with the ACCI and preop-erative NLR can effectively improve the predictive accuracy of the prognosis of patients with GC. In clinical practice, the ANLR could be considered a supplement to the traditional staging system to improve the prognosis evaluation of GC patients and guide indi-vidualized treatment strategies.
Lin JX, Huang YQ, Zheng CH, Huang CM and Li P conceived of the study, analyzed the data, and drafted the manuscript; Tu RH, Li P, Xie JW, Wang JB, and Li P helped revise the manuscript critically for important intellectual content; Lu J, Chen QY, Cao LL, and Lin M helped collect data and design the study.
The authors thank all the medical staff who contributed to the maintenance of the medical record database.
Appendix A. Supplementary data
This study was supported by the Scientific and technological innovation joint capital projects of Fujian Province, China (No.2016Y9031) and Minimally invasive medical center of Fujian Province (No. 171).
Conflict of interest
There are no conflicts of interest or financial ties to disclose from any of author.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimenta-tion (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or a substitute for it was obtained from all patients for being included in the study.
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