Systemic inflammatory markers (SIM) are closely related to the prognosis of various tumors. However, most of the studies were mainly limited to examining the preoperative level of these markers to evaluate prognosis. Reports on the significance of postoperative SIM in predicting the long-term prognosis of gastric cancer (GC) were rare. Therefore, this study aims to explore the preoperative and postoperative longitudinal changes of SIM in patients with GC and the impact on long-term prognosis.
The prospectively collected data from 2180 patients with GC who underwent radical gastrectomy between January 2009 and December 2014 at Fujian Medical University Union Hospital (FMUUH) were retrospectively analyzed. Changes in SIM between preoperatively and 1-6 months and 12 months postoperatively were reported. Cox univariate and multivariate analyses were performed to determine the prognosis of GC.
In multivariate analysis, higher preoperative systemic inflammation score (pre-SIS) was independent predictor of poor prognosis (P <0.05). Further analysis showed that the area under the curve (AUC) of pre-SIS for prediction of 5-year overall survival (OS) was highest [0.605 (95% CI 0.584-0.6250)]. The optimal time of remeasurement was 12 months postoperatively, based on a longitudinal profile of SIS and accuracy in predicting 5-year OS [AUC: 0.712 (95% CI 0.630 - 0.785)]. According to the association between the conversion of SIS and OS, we classified patients into three risk groups. Kaplan-Meier (K-M) curves showed significant differences in OS among risk groups. Further Cox multivariate regression analysis showed that only risk groups of SIS and pTNM stage were independent prognostic factors for OS.
The efficacy of SIS in predicting prognosis 12 months after surgery is superior, and the elevation of SIS 12 months after surgery predicts poor prognosis. These findings provide support for the remeasurement of SIS 12 months after surgery.
Scientific and Technological Innovation Joint Capital Projects of Fujian Province.
All authors have declared no conflicts of interest.