The sodium/D-dimer ratio predicts the effect of first-line chemotherapy and prognosis in patients with advanced gastric cancer

Abstract

Background: Gastric cancer (GC) is one of the most common cancers worldwide. The survival time of patients with advanced gastric cancer (AGC) is shortened. We evaluated the role of the sodium/fibrinogen ratio (SFR) and sodium/D-dimer ratio (SDR) in predicting the first-line chemotherapy response, progression-free survival (PFS), and overall survival (OS) of patients with AGC.

Methods: A total of 304 patients with AGC were retrospectively reviewed. SDR only was selected as a potential prognostic marker for the subsequent studies in this study. Based on the cut-off value of the SDR, the patients were divided into high-SDR and low-SDR groups and investigated for their clinicopathological features, first-line chemotherapy effects and clinical outcomes.

Results: The cut-off value based on the SDR was 282.22, and the patients were divided into low-SDR (SDR ≤ 282.22) and high-SDR (SDR > 282.22) groups. The disease control rate was higher in the high-SDR group than in the low-SDR group (91.1% vs. 82.3%; P = 0.036). Patients with a high SDR had a longer median PFS and OS than those with a low SDR (PFS: 206.0 vs. 134.0 days, P < 0.001; OS: 435.0 vs. 295.5 days, P < 0.001). The SDR was an independent prognostic indicator in the multivariable analysis of PFS (P < 0.001) and OS (P = 0.004). In subgroup analyses, among the patients with normal sodium and D-dimer levels, SDR was still a reliable prognostic indicator of PFS and OS in patients with AGC (all P ≤ 0.001).

Conclusions: This study suggests that the SDR may serve as a prognostic indicator for chemotherapy outcome, PFS and OS for patients with AGC receiving first-line chemotherapy.

Keywords: Sodium/D-dimer ratio; first-line chemotherapy; gastric cancer; overall survival; prognosis; progression-free survival.

Figure 1

ROC curves for the ability of pre-treatment SDR and SFR to predict OS for patients with AGC. ROC, receiver operating characteristic; SFR, sodium/fibrinogen ratio; SDR, sodium/D-dimer ratio; AGC, advanced gastric cancer.

Figure 2

Relationship between the (A) DCR and (B) ORR and the SDR value. The proportion of patients achieving (C) DCR and (D) ORR in the low-SDR group and high-SDR group. In the violin plots, the horizontal dotted lines indicate Q1 and Q3, and the horizontal bars within the violin indicate the median. *, P < 0.05; **, P < 0.01; ns, P > 0.05; SDR, sodium/D-dimer ratio; PD, progressive disease; SD, stable disease; DCR, disease control rate; ORR, objective response rate; Q1, first quartile; Q3, third quartile.

Figure 3

Kaplan-Meier estimates of (A) PFS and (B) OS in patients with low SDR and high SDR. SDR, sodium/D-dimer ratio; PFS, progression-free survival; OS, overall survival.

Figure 4

Subgroup analysis for the association between the SDR and PFS and OS in the subgroups stratified by (A and B) normal sodium level and (C and D) normal D-dimer level. SDR, sodium/D-dimer ratio; PFS, progression-free survival; OS, overall survival.