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Vitamin D-based score in gastric cancer
Background
Several molecular studies have explored different biomarkers to stratify gastric patients according to their relapse risk. Most of them are difficult to translate into routine practice because of expensive cost or required infrastructure. This study explores the prognosis impact of severe deficit of vitamin D (VD), nutritional, immune and clinical parameters in a score in local gastric cancer (LGC). Vitamin D function is related with carcinogenesis and tumoral progression through gene expression regulation.
Methods
An ambispective, observational and multicentric study was conducted from 2015 to 2021 in eight university Spanish hospitals of the Galician Research Group on Digestive Tumors (GITuD). Seventy-seven patients with LGC treated with surgery (IQ) or perioperative chemotherapy (CT). Analytical levels and clinical features were measured prior to treatment. Severe deficit of vitamin D (< 1.0 mg/dL; nutritional markers: albumin 1 and severe deficit of vitamin D (assigning one point for each factor). Patients with score 0-1 were stratify as low risk, score 2-3 as moderate risk and score 4 as high risk. Levels of these data were related to time-to-relapse (TTR) and OS by Kaplan-Meier and compared by long-rank test and univariate analysis were carried out.
Results
Median age was 68.69 years old, 33.8% female, 60.9% had no comorbidity, 75.7% had PS ≤ 1, 40.3% pts were resected and 59.7% received CT, T3 were similar in CT and IQ groups (51.5% vs 48.5%, p=0.09), intestinal type (57.7% vs 42.3%, p=0.53). Median follow-up: 37.12 months, median DFS: 28.15months (1.05 -55.08), median OS: 41.26 months (26.87-55.64). Severe deficit of vitamin D was correlated with significantly shorter OS: 27.89 vs 54.63 months, p=0.043. Inflammatory, nutritional and clinical markers were correlated with significantly shorter OS: CRP > 1.0 mg/dL (25.88 vs 54.63 vs NA, p=0.014), albumin 1 (20.30 vs 50.04 p=0.004). Univariate analysis indicated that patients with high risk PALV score were associated with significant shorter median OS (8.67months vs 28.25 months moderate risk vs 59.01 months low risk, p Multivariate analysis showed that high risk PALV score was related with poor overall survival compared with moderated (HR: 0.45, 95% CI: 0.003 – 0.594, p= 0.019) and low risk (HR: 0.37, 95% CI: 0.004 – 0.356, p= 0.004) adjusted by sex, CEA level, vascular invasion and treatment (IQ vs CT).
Conclusions
Severe deficit of vitamin D and Vitamin D-based score (PALV) were related with statistically significant shorter median OS. This classification system can be translated to routine clinical practice.
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosures
A. Fernández Montes: Advisory / Consultancy: Bayer; Speaker Bureau / Expert testimony: Bayer. All other authors have declared no conflicts of interest.
