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Accurate Prediction of Prognosis After Radical Resection of Gastric Cancer by the Modified Systemic Inflammation Score; a Multicenter Dataset Analysis

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Abstract

Background

The presence of chronic inflammation and nutritional status in cancer patients affects its prognosis. There is a clinical need for a prognostic predictor that is objective and accurate, and that can be easily evaluated by preoperative screening. We evaluated the importance and usefulness of the preoperative modified systemic inflammation score (mSIS) to predict the long-term outcome of patients undergoing curative resection for gastric cancer (GC).

Methods

Of the 3571 patients who underwent curative resection for GC in nine institutions between January 2010 and December 2014, 1764 patients who met the inclusion criteria were included. The mSIS was formulated according to the serum albumin level (ALB) and lymphocyte-to-monocyte ratio (LMR) as follows: mSIS 0 (ALB ≥ 4.0 g/dL and LMR ≥ 3.4), mSIS 1 (ALB < 4.0 g/dL or LMR < 3.4), and mSIS 2 (ALB < 4.0 g/dL and LMR < 3.4).

Results

Patients were categorized into preoperative mSIS 0 (n = 955), mSIS 1 (n = 584), and mSIS 2 (n = 225) groups. The overall survival times and the disease-free survival times of patients in preoperative mSIS 0,1 and 2 sequentially shortened (P < 0.0001), and mSIS 1 and 2 were identified as an independent prognostic factor (hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.06–1.272, P = 0.0125 and HR 1.63, 95% CI 1.21–2.19, P = 0.0012). A stepwise increase in the prevalence of hematogenous recurrences was directly proportional to the mSIS. A forest plot revealed that mSIS 0,1 was associated with a greater risk of overall survival in most subgroups.

Conclusion

Preoperative mSIS can be easily calculated, and it is suggested that it is useful as a prognostic predictor of patients with different disease stages, for stratifying and evaluating clinical outcomes.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Kota Inagaki, Mitsuro Kanda, Koki Nakanishi, Chie Tanaka, Daisuke Kobayashi, Michitaka Fujiwara & Yasuhiro Kodera

  2. Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan

    Seiji Ito

  3. Department of Surgery, Komaki City Hospital, Komaki, Japan

    Yoshinari Mochizuki

  4. Department of Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan

    Hitoshi Teramoto

  5. Department of Surgery, Konan Kosei Hospital, Konan, Japan

    Kiyoshi Ishigure

  6. Department of Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan

    Toshifumi Murai

  7. Department of Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan

    Takahiro Asada

  8. Department of Surgery, Okazaki City Hospital, Okazaki, Japan

    Akiharu Ishiyama

  9. Department of Surgery, Tosei General Hospital, Seto, Japan

    Hidenobu Matsushita

  10. Biostatistics Center, Graduate School of Medicine, Kurume University, Kurume, Japan

    Kenta Murotani

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  1. Kota Inagaki
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  2. Mitsuro Kanda
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Corresponding author

Correspondence to Mitsuro Kanda.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Inagaki, K., Kanda, M., Nakanishi, K. et al. Accurate Prediction of Prognosis After Radical Resection of Gastric Cancer by the Modified Systemic Inflammation Score; a Multicenter Dataset Analysis. World J Surg 45, 2513–2520 (2021). https://doi.org/10.1007/s00268-021-06138-9

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  • DOI: https://doi.org/10.1007/s00268-021-06138-9

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