Jian-Xian Lin1,2,3, Jun-Peng Lin1,2, Jian-Wei Xie1,2,3, Jia-Bin Wang1,2,3, Jun Lu1,2, Qi-Yue Chen1,2, Long-Long Cao1,2, Mi Lin1,2, Ruhong Tu1,2, Chao-Hui Zheng4,5,6, Chang-Ming Huang7,8,9, Ping Li10,11,12. 1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China. 2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China. 3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China. 4. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China. wwkzch@163.com. 5. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China. wwkzch@163.com. 6. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China. wwkzch@163.com. 7. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China. hcmlr2002@163.com. 8. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China. hcmlr2002@163.com. 9. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China. hcmlr2002@163.com. 10. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China. Pingli811002@163.com. 11. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China. Pingli811002@163.com. 12. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China. Pingli811002@163.com.
Abstract
BACKGROUND: The systemic inflammation score (SIS), based on preoperative serum albumin (Alb) level and lymphocyte-to-monocyte ratio (LMR), has been shown to be a novel prognostic score for some tumors. We investigate the prognostic value of the SIS in patients with resectable gastric cancer (GC). METHODS: Patients with GC who underwent curative resection between December 2008 and December 2013 were included. Time-dependent receiver operating characteristics analysis (t-ROC), concordance index (C-index) and AUC were used to compare the prognostic impact. RESULTS: Totally, 1786 patients with resectable GC were included in the study. By multivariate analysis, the SIS was not an independent prognostic factor. However, the normal Alb level (≥ 40 g/l) and LMR ≥ 3.4 both remained independent protective factors for GC (both P < 0.05). Due to the similar survival of patients with LMR ≥ 3.4 and LMR < 3.4 in the normal Alb group, we combined the two subgroups to establish the modified SIS (mSIS). Multivariate analysis revealed that the mSIS was the only significant independent biomarker (P < 0.05). The t-ROC curve and C-index for the mSIS were superior to those of the SIS throughout the observation period. Furthermore, the AUC of the mSIS was significantly greater than that of the SIS at 3 and 5 years after operation (both P < 0.05). CONCLUSION: The preoperative mSIS is a novel, simple and useful prognostic factor for postoperative survival in patients with GC and can be used as a part of the preoperative risk stratification process to improve the prediction of clinical outcomes.
BACKGROUND: The systemic inflammation score (SIS), based on preoperative serum albumin (Alb) level and lymphocyte-to-monocyte ratio (LMR), has been shown to be a novel prognostic score for some tumors. We investigate the prognostic value of the SIS in patients with resectable gastric cancer (GC). METHODS:Patients with GC who underwent curative resection between December 2008 and December 2013 were included. Time-dependent receiver operating characteristics analysis (t-ROC), concordance index (C-index) and AUC were used to compare the prognostic impact. RESULTS: Totally, 1786 patients with resectable GC were included in the study. By multivariate analysis, the SIS was not an independent prognostic factor. However, the normal Alb level (≥ 40 g/l) and LMR ≥ 3.4 both remained independent protective factors for GC (both P < 0.05). Due to the similar survival of patients with LMR ≥ 3.4 and LMR < 3.4 in the normal Alb group, we combined the two subgroups to establish the modified SIS (mSIS). Multivariate analysis revealed that the mSIS was the only significant independent biomarker (P < 0.05). The t-ROC curve and C-index for the mSIS were superior to those of the SIS throughout the observation period. Furthermore, the AUC of the mSIS was significantly greater than that of the SIS at 3 and 5 years after operation (both P < 0.05). CONCLUSION: The preoperative mSIS is a novel, simple and useful prognostic factor for postoperative survival in patients with GC and can be used as a part of the preoperative risk stratification process to improve the prediction of clinical outcomes.