Prognostic importance of the preoperative modified systemic inflammation score for patients with gastric cancer
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).
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.
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).
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.
KeywordsGastric cancer Systemic inflammation score Lymphocyte-to-monocyte ratio Albumin Prognosis
Scientific and technological innovation joint capital projects of Fujian Province, China (no. 2016Y9031). Minimally invasive medical center of Fujian Province (no. 171). Project supported by the Science Foundation of the Fujian Province, China (Grant no. 2018J01307). Startup Fund for scientific research, Fujian Medical University (no. 2016QH024).
LJX, LJP, ZCH, HCM and LP conceived of the study, analyzed the data, and drafted the manuscript; TRH, LP, XJW, WJB, and LP helped revise the manuscript critically for important intellectual content; LJ, CQY, CLL, and LM helped collect data and design the study.
Compliance with ethical standards
Conflict of interest
There are no conflicts of interest or financial ties to disclose from any of author.
Human rights statement
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.
Informed consent or substitute for it was obtained from all patients for being included in the study.
- 8.Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;2:113–23.Google Scholar
- 9.Edge SB, Byrd D. AJCC Cancer Staging Manual. 7th ed. New York: Springer; 2010.Google Scholar