The Preoperative Albumin-to-Carcinoembryonic Antigen Ratio (ACR) Predicts Prognosis and Facilitates Risk Stratification in Gastric Cancer: A Retrospective Cohort Study

Why It Matters

ACR merges nutritional and tumor‑burden information into a cheap, widely available biomarker, refining prognosis beyond TNM staging and allowing clinicians to tailor surveillance and therapy for gastric‑cancer patients.

Key Takeaways

• Low pre‑operative ACR predicts poorer overall and disease‑free survival
• ACR‑based nomogram outperforms TNM staging (C‑index 0.748 vs 0.724)
• High ACR associated with less aggressive tumor features and lower recurrence
• Study of 1,161 Chinese gastric cancer patients validates ACR as prognostic factor

Pulse Analysis

Gastric cancer remains a leading cause of cancer mortality worldwide, with survival outcomes varying dramatically even within the same TNM stage. Clinicians have therefore turned to composite biomarkers that capture both host and tumor biology. The albumin‑to‑carcinoembryonic antigen ratio (ACR) is one such metric, reflecting nutritional status through serum albumin and tumor burden via CEA. By integrating these dimensions, ACR offers a more nuanced risk profile than traditional staging alone, addressing the long‑standing need for affordable, easily measurable prognostic tools.

In the recent single‑center analysis of 1,161 patients from Shanxi Province Cancer Hospital, a low pre‑operative ACR identified individuals with markedly inferior overall and disease‑free survival. Multivariate models confirmed high ACR as an independent protective factor, and an ACR‑based nomogram delivered C‑indices of 0.748 for overall survival and 0.730 for disease‑free survival—both statistically superior to the TNM system. The model’s robust discrimination persisted across training and validation subsets, suggesting that incorporating ACR into routine pre‑operative labs could sharpen patient stratification without adding cost or complexity.

The broader implication is a shift toward personalized postoperative pathways: patients flagged by low ACR could receive intensified monitoring, adjuvant therapy, or nutritional interventions, while those with high ACR might avoid overtreatment. Nevertheless, the study’s retrospective, single‑institution design limits generalizability, and external validation in diverse populations is essential. Future research should explore dynamic ACR changes during treatment and assess whether integrating ACR with emerging molecular markers further enhances prognostic accuracy, paving the way for truly individualized gastric‑cancer care.