Hiroyuki Inoue1, Toshiyuki Kosuga2,3, Takeshi Kubota1, Hirotaka Konishi1, Atsushi Shiozaki1, Kazuma Okamoto1, Hitoshi Fujiwara1, Eigo Otsuji1. 1. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan. 2. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan. toti-k@koto.kpu-m.ac.jp. 3. Department of Surgery, Saiseikai Shiga Hospital, Ritto, Shiga, Japan. toti-k@koto.kpu-m.ac.jp.
Abstract
BACKGROUND: Since inflammation and the immune system contribute to the development and progression of malignancies, parameters that reflect a host's immune-inflammatory status may be useful prognostic indicators of gastric cancer (GC). The present study examined the clinical significance of a preoperative systemic immune-inflammation index (SII) for predicting postoperative survival outcomes in GC. METHODS: A total of 447 patients who underwent curative gastrectomy for GC were included in the present study. SII was calculated as platelet count × neutrophil count/lymphocyte count. The prognostic impact of preoperative SII was examined using univariate and multivariate analyses. RESULTS: Preoperative SII ranged between 105 and 4455 (median 474), and the optimal cutoff value for predicting overall survival (OS) was 395 based on a receiver operating characteristic curve. The 5-year OS rate of the SII ≥ 395 group was 80.0%, which was significantly worse than that (92.7%) of the SII < 395 group (p < 0.001). The multivariate analysis identified SII ≥ 395 (hazard ratio [HR] 2.95; 95% confidence interval [CI] 1.49-6.39; p = 0.001), heart disease (HR 2.14, 95% CI 1.07-4.07), C-reactive protein ≥ 0.5 (HR 2.45, 95% CI 1.15-4.94), pT4 (HR 4.46, 95% CI 2.44-8.14), and pN+ (HR 4.02, 95% CI 2.10-7.93) as independent predictors of worse OS. Peritoneal recurrence was more frequent in the high SII group than in the low SII group (p = 0.028). CONCLUSION: Preoperative SII may be a useful predictor of postoperative survival outcomes in GC. The meticulous surveillance of GC relapse, particularly peritoneal dissemination, is necessary for patients with SII ≥ 395 even after curative gastrectomy.
BACKGROUND: Since inflammation and the immune system contribute to the development and progression of malignancies, parameters that reflect a host's immune-inflammatory status may be useful prognostic indicators of gastric cancer (GC). The present study examined the clinical significance of a preoperative systemic immune-inflammation index (SII) for predicting postoperative survival outcomes in GC. METHODS: A total of 447 patients who underwent curative gastrectomy for GC were included in the present study. SII was calculated as platelet count × neutrophil count/lymphocyte count. The prognostic impact of preoperative SII was examined using univariate and multivariate analyses. RESULTS: Preoperative SII ranged between 105 and 4455 (median 474), and the optimal cutoff value for predicting overall survival (OS) was 395 based on a receiver operating characteristic curve. The 5-year OS rate of the SII ≥ 395 group was 80.0%, which was significantly worse than that (92.7%) of the SII < 395 group (p < 0.001). The multivariate analysis identified SII ≥ 395 (hazard ratio [HR] 2.95; 95% confidence interval [CI] 1.49-6.39; p = 0.001), heart disease (HR 2.14, 95% CI 1.07-4.07), C-reactive protein ≥ 0.5 (HR 2.45, 95% CI 1.15-4.94), pT4 (HR 4.46, 95% CI 2.44-8.14), and pN+ (HR 4.02, 95% CI 2.10-7.93) as independent predictors of worse OS. Peritoneal recurrence was more frequent in the high SII group than in the low SII group (p = 0.028). CONCLUSION: Preoperative SII may be a useful predictor of postoperative survival outcomes in GC. The meticulous surveillance of GC relapse, particularly peritoneal dissemination, is necessary for patients with SII ≥ 395 even after curative gastrectomy.
Entities:
Keywords:
Gastrectomy; Gastric cancer; Prognosis; Systemic immune-inflammation index
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