J Gastric Cancer.  2019 Jun;19(2):183-192. 10.5230/jgc.2019.19.e15.

Albumin-Bilirubin Score Predicts Tolerability to Adjuvant S-1 Monotherapy after Curative Gastrectomy

• Miwa T
• Kanda M
• Tanaka C
• Kobayashi
• Hayashi M
• Yamada S
• Nakayama G
• Koike M
• Kodera Y

• KMID: 2449939
• DOI: http://doi.org/10.5230/jgc.2019.19.e15

Abstract

PURPOSE
Due to adverse events, dose reduction or withdrawal of adjuvant chemotherapy is required for some patients. To identify the predictive factors for tolerability to postoperative adjuvant S-1 monotherapy in gastric cancer (GC) patients, we evaluated the predictive values of blood indicators.
MATERIALS AND METHODS
We analyzed 98 patients with pStage II/III GC who underwent postoperative adjuvant S-1 monotherapy. We retrospectively analyzed correlations between 14 parameters obtained from perioperative routine blood tests to assess their influence on the withdrawal of postoperative adjuvant S-1 monotherapy, within 6 months after discontinuation.
RESULTS
Postoperative adjuvant chemotherapy was discontinued in 21 patients (21.4%) within 6 months. Univariable analysis revealed that high preoperative albumin-bilirubin (ALBI) scores had the highest odds ratio (OR) for predicting the failure of adjuvant S-1 chemotherapy (OR, 6.47; 95% confidence interval [CI], 2.08-20.1; cutoff value, -2.696). The high ALBI group had a significantly shorter time to failure of postoperative adjuvant S-1monotherapy (hazard ratio, 3.48; 95% CI, 1.69-7.25; P=0.001). Multivariable analysis identified high preoperative ALBI score as an independent prognostic factor for tolerability (OR, 10.3; 95% CI, 2.33-45.8; P=0.002).
CONCLUSIONS
Preoperative ALBI shows promise as an indicator associated with the tolerability of adjuvant S-1 monotherapy in patients with pStage II/III GC.

Keyword

Gastric cancer; S-1; Adjuvant chemotherapy; Biomarker; Albumin-bilirubin score

MeSH Terms

Chemotherapy, Adjuvant
Drug Therapy
Gastrectomy*
Hematologic Tests
Humans
Odds Ratio
Retrospective Studies
Stomach Neoplasms

Figure

• 

  Fig. 1 (A) OS of patients with pStage II/III gastric cancer with or without 6 months of S-1 postoperative adjuvant monotherapy. (B) Preoperative study parameters and ORs. OS = overall survival; OR = odds ratio; HR = hazard ratio; CI = confidence interval; WBC = white blood cell; Neu = neutrophil count; TLC = total lymphocyte count; Plt = platelet count; TP = total protein; Alb = albumin; ChE = cholinesterase; T-Bil = total bilirubin; AST = aspartate aminotransferase; ALT = alanine aminotransferase; CCr = creatinine clearance; ALBI = albumin-bilirubin; PLR = platelet-lymphocyte ratio; PNI = prognostic nutritional index.

• 

  Fig. 2 (A) ORs of ALBI scores and its variables before surgery and postoperative adjuvant chemotherapy initiation and perioperative changes. (B) Time-to-treatment failure of postoperative adjuvant S-1 monotherapy with high and low ALBI scores. OR = odds ratio; ALBI = albumin-bilirubin; HR = hazard ratio; CI = confidence interval; Alb = albumin; T-Bil = total bilirubin.

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