Elsevier

Surgery

Volume 172, Issue 1, July 2022, Pages 150-159
Surgery

Gastric
Correlations of preoperative systematic immuno-inflammatory index and prognostic nutrition index with a prognosis of patients after radical gastric cancer surgery

https://doi.org/10.1016/j.surg.2022.01.006Get rights and content

Abstract

Background

This study aimed to explore the correlations of a preoperative systemic immune-inflammation index and prognostic nutritional index with the prognosis of patients after radical gastric cancer surgery.

Methods

The receiver operating characteristic curve determined the optimal cut-off values of systemic immune-inflammation index, prognostic nutritional index, platelet-to-lymphocyte ratio, and neutrophil-to-lymphocyte ratio. Kaplan-Meier method and Cox proportional hazards model were used to evaluate the correlation between systemic immune-inflammation index, prognostic nutritional index, platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, and patient prognosis. Finally, the receiver operating characteristic curve was adopted to evaluate the efficiency of systemic immune-inflammation index, prognostic nutritional index, and combination of systemic immune-inflammation index and prognostic nutritional index in predicting the prognosis of gastric cancer.

Results

We retrospectively analyzed 771 patients from June 2010 to June 2015. The results of Kaplan-Meier analysis showed that the 5-year overall survival was significantly higher in the low systemic immune-inflammation index group than in the high systemic immune-inflammation index group (67.9% vs 28.9%, P < .001), and significantly lower in the low prognostic nutritional index group than in the high prognostic nutritional index group (46.2% vs 74.2%, P < .001). Systemic immune-inflammation index and prognostic nutritional index were independent risk factors for the prognosis of patients with gastric cancer. The results of receiver operating characteristic curve analysis demonstrated that the area under the curve of combining systemic immune-inflammation index and prognostic nutritional index was the largest (area under the curve = 0.747, P < .001), showing statistically significant differences between groups (P < .05), so combining systemic immune-inflammation index and prognostic nutritional index has higher prediction efficiency.

Conclusion

Systemic immune-inflammation index and prognostic nutritional index are independent risk factors for the prognosis of patients with gastric cancer. The decrease in systemic immune-inflammation index and the increase in prognostic nutritional index suggest a better prognosis, and the combination of systemic immune-inflammation index and prognostic nutritional index can improve the prediction efficiency.

Introduction

According to the GLOBOCAN data of the World Health Organization,1 9.6 million people died of cancer in 2018, accounting for about one sixth of the total deaths, and 782,000 were caused by gastric cancer, ranking second. The modern diagnosis and treatment system has been continuously improved in recent years. However, the early symptoms of gastric cancer are not obvious, and most of the patients are diagnosed in the advanced stage, so operation difficulty is increased. Consequently, 35% to 70% of the patients still have recurrence and metastasis within 5 years after the operation, and the prognosis is poor. Moreover, Helicobacter pylori infection and the presence of circulating tumor cells also dramatically reduce the 5-year survival of patients with gastric cancer.2, 3, 4, 5

Up to now, the tumor-node-metastasis (TNM) staging system has been a vital evaluation system for guiding clinical treatment and assessing prognosis.6 However, the TNM staging system is not perfect, and gene analysis and molecular spectrum analysis are expensive and complicated,7 so searching for convenient biomarkers is helpful for the determination of clinical treatment strategies and more accurate prognostic evaluation. Studies in recent years have confirmed that systemic immune-inflammation index (SII) and prognostic nutritional index (PNI) are closely associated with the prognosis of patients with gastric cancer.8,9 The current study found that combining SII and PNI (coSII-PNI) is more effective than SII or PNI alone in predicting the prognosis of patients with cancer.10, 11, 12 However, the combined application of SII and PNI in predicting the prognosis of patients with gastric cancer has not been explored. Therefore, this study aimed to explore the efficiency of SII and PNI in evaluating the prognosis of patients undergoing radical gastrectomy based on which the value of coSII-PNI in evaluating the prognosis of gastric cancer was further investigated.

Section snippets

General data

The clinical data of patients with gastric cancer admitted to the Department of Gastrointestinal Surgery of Qinghai University Affiliated Hospital and treated with surgery from June 2010 to June 2015 were analyzed retrospectively. The inclusion criteria were: (1) patients pathologically diagnosed with gastric mucosal adenocarcinoma before the operation, (2) those who underwent surgical treatment for gastric cancer and received standardized lymph node dissection, and (3) those with complete

General data

Our study enrolled 771 patients in total according to the inclusion and the exclusion criteria, including 165 females (21.4%) and 606 males (78.6%), with a median age of 58.2 years old. The pathology confirmed gastric mucosal adenocarcinoma before and after the operation, and postoperative complications caused no death. Radical gastrectomy for distal gastric cancer was performed in 297 cases (38.5%), radical gastrectomy for proximal gastric cancer in 250 cases (32.4%), and total gastrectomy in

Discussion

In recent years, an increasing number of studies have revealed that inflammation plays an essential role in the occurrence, development, and metastasis of malignancies.16 Some biomarkers such as C-reactive protein, NLR, PLR, and SII are closely associated with the prognosis of patients with cancer and have potential clinical significance for monitoring the prognosis of such patients.17,18 Wang et al19 retrospectively analyzed the clinical data of 444 patients with gastric cancer who underwent

Funding/Support

This work was supported by the Key R & D and Transformation Program of Qinghai Province – Special Project of Science and Technology Assistance (No. 2021-QY-213); the CAS (Light of the West China) Program (No. 2019–33), the National Natural Science Foundation of China (No. 81460429), the Open Project of State Key Laboratory of Plateau Ecology and Agriculture, Qinghai University (No. 2019-ZZ-07), and the Scientific Research Project of Research Team of Medical College of Qinghai University (No.

Conflict of interest/Disclosure

All the authors declare no conflicts of interest.

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    • Cited by (5)

    Xu Zhaojun, Chen Xiaobin, and Yuan Jiaqi contributed equally to this work.

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