1Yonsei University College of Medicine, Seoul, Korea
2Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
3Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
4Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
5Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
6Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
7Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Copyright © 2023 by the Korean Cancer Association
This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ethical Statement
This research was approved by the Institutional Review Boards (IRB No. 3-2022-0072). Informed consent was waived for this retrospective study.
Author Contributions
Conceived and designed the analysis: Kang J.
Collected the data: Cho ES, Koh HH, Lee KY, Kang J.
Contributed data or analysis tools: Lee JH, Shin SJ, Kang J.
Performed the analysis: Kim D, Lee JH, Lee HS, Kang J.
Wrote the paper: Kim D, Kang J.
Conflicts of Interest
Conflict of interest relevant to this article was not reported.
Patient characteristics according to the low and high ALBI groups
Variable | Low ALBI-pre group (n=586) | High ALBI-pre group (n=137) | p-value | Low ALBI-post group (n=615) | High ALBI-post group (n=108) | p-value |
---|---|---|---|---|---|---|
Sex | ||||||
Female | 238 (40.6) | 54 (39.4) | 263 (42.8) | 29 (26.9) | ||
Male | 348 (59.4) | 83 (60.6) | 0.872 | 352 (57.2) | 79 (73.1) | 0.003 |
Age (yr) | ||||||
< 70 | 453 (77.3) | 80 (58.4) | 476 (77.4) | 57 (52.8) | ||
≥ 70 | 133 (22.7) | 57 (41.6) | < 0.001 | 139 (22.6) | 51 (47.2) | < 0.001 |
BMI (kg/m2) | 23.5±2.9 | 22.6±3.4 | 0.004 | 23.3±2.8 | 23.5±3.8 | 0.653 |
CEA (ng/mL) | ||||||
< 5 | 355 (60.6) | 75 (54.7) | 374 (60.8) | 56 (51.9) | ||
≥ 5 | 215 (36.7) | 57 (41.6) | 221 (35.9) | 51 (47.2) | ||
Unknown | 16 (2.7) | 5 (3.6) | 0.433 | 20 (3.3) | 1 (0.9) | 0.048 |
Tumor location | ||||||
Colon | 415 (70.8) | 118 (86.1) | 461 (75.0) | 72 (66.7) | ||
Rectum | 171 (29.2) | 19 (13.9) | < 0.001 | 154 (25.0) | 36 (33.3) | 0.092 |
Tumor size (cm) | ||||||
< 5 | 344 (58.7) | 51 (37.2) | 342 (55.6) | 53 (49.1) | ||
≥ 5 | 242 (41.3) | 86 (62.8) | < 0.001 | 273 (44.4) | 55 (50.9) | 0.249 |
Histologic grade | ||||||
G1 & G2 | 540 (92.2) | 123 (89.8) | 565 (91.9) | 98 (90.7) | ||
G3 & MC & SRC | 46 (7.8) | 14 (10.2) | 0.464 | 50 (8.1) | 10 (9.3) | 0.839 |
LVI | ||||||
Absent | 404 (68.9) | 90 (65.7) | 422 (68.6) | 72 (66.7) | ||
Present | 169 (28.8) | 44 (32.1) | 180 (29.3) | 33 (30.6) | ||
Unknown | 13 (2.2) | 3 (2.2) | 0.749 | 13 (2.1) | 3 (2.8) | 0.867 |
Stage | ||||||
I & II | 216 (36.9) | 53 (38.7) | 229 (37.2) | 40 (37.0) | ||
III | 290 (49.5) | 53 (38.7) | 299 (48.6) | 44 (40.7) | ||
IV | 80 (13.7) | 31 (22.6) | 0.013 | 87 (14.1) | 24 (22.2) | 0.078 |
Metastatectomy in stage IV | ||||||
R0 resection | 62 (77.5) | 14 (45.2) | 60 (69.0) | 16 (66.7) | ||
R1 or R2 resection | 18 (22.5) | 17 (54.8) | 0.002 | 27 (31.0) | 8 (33.3) | > 0.99 |
Complications | ||||||
No | 447 (76.3) | 85 (62.0) | 493 (80.2) | 39 (36.1) | ||
Yes | 139 (23.7) | 52 (38.0) | 0.001 | 122 (19.8) | 69 (63.9) | < 0.001 |
Chemotherapy | ||||||
No | 112 (19.1) | 50 (36.5) | 114 (18.5) | 48 (44.4) | ||
Yes | 474 (80.9) | 87 (63.5) | < 0.001 | 501 (81.5) | 60 (55.6) | < 0.001 |
Values are presented as number (%) or mean±SD. ALBI, albumin-bilirubin; BMI, body mass index; CEA, carcinoembryonic antigen; LVI, lymphovascular invasion; MC, mucinous adenocarcinoma; SD, standard deviation; SRC, signet-ring cell.
Patient characteristics according to the ALBI-trend
Variable | Group 1 (n=523) | Group 2 (n=63) | Group 3 (n=92) | Group 4 (n=45) | p-value |
---|---|---|---|---|---|
Sex | |||||
Female | 221 (42.3) | 17 (27.0) | 42 (45.7) | 12 (26.7) | |
Male | 302 (57.7) | 46 (73.0) | 50 (54.3) | 33 (73.3) | 0.018 |
Age (yr) | |||||
< 70 | 414 (79.2) | 39 (61.9) | 62 (67.4) | 18 (40.0) | |
≥ 70 | 109 (20.8) | 24 (38.1) | 30 (32.6) | 27 (60.0) | < 0.001 |
BMI (kg/m2) | 23.4±2.8 | 23.9±3.7 | 22.5±3.1 | 22.8±3.9 | 0.008 |
CEA (ng/mL) | |||||
< 5 | 318 (60.8) | 37 (58.7) | 56 (60.9) | 19 (42.2) | |
≥ 5 | 189 (36.1) | 26 (41.3) | 32 (34.8) | 25 (55.6) | |
Unknown | 16 (3.1) | 0 | 4 (4.3) | 1 (2.2) | 0.142 |
Tumor location | |||||
Colon | 381 (72.8) | 34 (54.0) | 80 (87.0) | 38 (84.4) | |
Rectum | 142 (27.2) | 29 (46.0) | 12 (13.0) | 7 (15.6) | < 0.001 |
Tumor size (cm) | |||||
< 5 | 311 (59.5) | 33 (52.4) | 31 (33.7) | 20 (44.4) | |
≥ 5 | 212 (40.5) | 30 (47.6) | 61 (66.3) | 25 (55.6) | < 0.001 |
Histologic grade | |||||
G1 & G2 | 484 (92.5) | 56 (88.9) | 81 (88.0) | 42 (93.3) | |
G3 & MC & SRC | 39 (7.5) | 7 (11.1) | 11 (12.0) | 3 (6.7) | 0.405 |
LVI | |||||
Absent | 359 (68.6) | 45 (71.4) | 63 (68.5) | 27 (60.0) | |
Present | 153 (29.3) | 16 (25.4) | 27 (29.3) | 17 (37.8) | |
Unknown | 11 (2.1) | 2 (3.2) | 2 (2.2) | 1 (2.2) | 0.894 |
Stage | |||||
I & II | 188 (35.9) | 28 (44.4) | 41 (44.6) | 12 (26.7) | |
III | 269 (51.4) | 21 (33.3) | 30 (32.6) | 23 (51.1) | |
IV | 66 (12.6) | 14 (22.2) | 21 (22.8) | 10 (22.2) | 0.001 |
Complications | |||||
No | 426 (81.5) | 21 (33.3) | 67 (72.8) | 18 (40.0) | |
Yes | 97 (18.5) | 42 (66.7) | 25 (27.2) | 27 (60.0) | < 0.001 |
Chemotherapy | |||||
No | 87 (16.6) | 25 (39.7) | 27 (29.3) | 23 (51.1) | |
Yes | 436 (83.4) | 38 (60.3) | 65 (70.7) | 22 (48.9) | < 0.001 |
Values are presented as number (%) or mean±SD. ALBI, albumin-bilirubin; BMI, body mass index; CEA, carcinoembryonic antigen; LVI, lymphovascular invasion; MC, mucinous adenocarcinoma; SD, standard deviation; SRC, signet-ring cell.
Univariable and multivariable analysis of factors associated with overall survival
Variable | Univariable analysis |
Multivariable analysis | ||
---|---|---|---|---|
HR (95% CI) | p-value | HR (95% CI) | p-value | |
Sex | ||||
Female | 1 | 1 | ||
Male | 1.358 (1.020–1.809) | 0.036 | 1.302 (0.972–1.743) | 0.075 |
Age (yr) | ||||
< 70 | 1 | 1 | ||
≥ 70 | 1.967 (1.487–2.602) | < 0.001 | 1.506 (1.120–2.025) | 0.006 |
BMI (kg/m2) | ||||
< 25 | 1 | |||
≥ 25 | 0.724 (0.521–1.004) | 0.053 | ||
CEA (ng/mL) | ||||
< 5 | 1 | 1 | ||
≥ 5 | 1.958 (1.487–2.577) | < 0.001 | 1.446 (1.076–1.943) | 0.014 |
Unknown | 1.066 (0.433–2.618) | 0.889 | 0.963 (0.387–2.395) | 0.935 |
Tumor location | ||||
Colon | 1 | |||
Rectum | 0.875 (0.638–1.201) | 0.410 | ||
Tumor size (cm) | ||||
< 5 | 1 | |||
≥ 5 | 1.591 (1.212–2.090) | < 0.001 | ||
Complications | ||||
No | 1 | |||
Yes | 1.634 (1.227–2.176) | < 0.001 | ||
Histologic grade | ||||
G1 & G2 | 1 | |||
G3 & MC & SRC | 1.002 (0.610–1.646) | 0.993 | ||
LVI | ||||
Absent | 1 | 1 | ||
Present | 2.133 (1.615–2.815) | < 0.001 | 1.491 (1.105–2.012) | 0.008 |
Unknown | 1.029 (0.379–2.788) | 0.955 | 0.541 (0.196–1.496) | 0.236 |
Stage | ||||
I & II | 1 | 1 | ||
III | 1.630 (1.152–2.305) | 0.005 | 1.876 (1.286–2.734) | < 0.001 |
IV | 5.405 (3.731–7.829) | < 0.001 | 3.723 (2.469–5.615) | < 0.001 |
Chemotherapy | ||||
No | 1 | 1 | ||
Yes | 0.316 (0.239–0.418) | < 0.001 | 0.410 (0.298–0.563) | < 0.001 |
ALBI-pre | ||||
Low | 1 | |||
High | 2.682 (2.013–3.573) | < 0.001 | ||
ALBI-post | ||||
Low | 1 | |||
High | 2.474 (1.811–3.38) | < 0.001 | ||
ALBI-trend | ||||
Group 1 | 1 | 1 | ||
Group 2 | 2.172 (1.408–3.350) | < 0.001 | 1.649 (1.054–2.582) | 0.028 |
Group 3 | 2.459 (1.730–3.495) | < 0.001 | 2.235 (1.559–3.205) | < 0.001 |
Group 4 | 4.392 (2.901–6.650) | < 0.001 | 2.477 (1.599–3.837) | < 0.001 |
ALBI, albumin-bilirubin; BMI, body mass index; CEA, carcinoembryonic antigen; CI, confidence interval; HR, hazard ratio; LVI, lymphovascular invasion; MC, mucinous adenocarcinoma; SRC, signet-ring cell.
Comparison of C-index between ALBI-trend with ALBI-pre or ALBI-post
Included variable | Overall survival | |||
---|---|---|---|---|
ALBI-trend | ALBI-pre | ALBI-trend | ALBI-post | |
C-index (95% CI) (bootstrapped) | 0.622 (0.587–0.655) | 0.589 (0.557–0.621) | 0.622 (0.587–0.655) | 0.575 (0.545–0.605) |
Difference | 0.033 (0.013–0.057) | 0.047 (0.024–0.074) |
ALBI, albumin-bilirubin; CI, confidence interval.
Values are presented as number (%) or mean±SD. ALBI, albumin-bilirubin; BMI, body mass index; CEA, carcinoembryonic antigen; LVI, lymphovascular invasion; MC, mucinous adenocarcinoma; SD, standard deviation; SRC, signet-ring cell.
Values are presented as number (%) or mean±SD. ALBI, albumin-bilirubin; BMI, body mass index; CEA, carcinoembryonic antigen; LVI, lymphovascular invasion; MC, mucinous adenocarcinoma; SD, standard deviation; SRC, signet-ring cell.
ALBI, albumin-bilirubin; BMI, body mass index; CEA, carcinoembryonic antigen; CI, confidence interval; HR, hazard ratio; LVI, lymphovascular invasion; MC, mucinous adenocarcinoma; SRC, signet-ring cell.
ALBI, albumin-bilirubin; CI, confidence interval.