The prognostic significance of the comprehensive complication index in patients with gastric cancer

  • Shota Shimizu
  • Hiroaki SaitoEmail author
  • Yusuke Kono
  • Yuki Murakami
  • Yuji Shishido
  • Kozo Miyatani
  • Tomoyuki Matsunaga
  • Yoji Fukumoto
  • Yoshiyuki Fujiwara
Original Article



Postoperative complications worsen the prognosis of gastric cancer patients. The Clavien–Dindo classification is used to evaluate postoperative complications. The prognostic significance of the comprehensive complication index (CCI), a new tool for evaluating postoperative complications, remains unclear.


This study included 452 gastric adenocarcinoma patients who underwent curative surgery.


The CCI values were significantly higher in older patients ( ≥ 70 years; P < 0.0001), male patients (P < 0.0001), those with lymphatic invasion (P = 0.039), and those with vascular invasion (P = 0.037). The five-year overall survival (OS) and disease-specific survival (DSS) rates were significantly higher in patients without postoperative complications and those with Clavien–Dindo grade 1 complications in comparison to those with Clavien–Dindo grade 2–4 complications (80.4% vs. 66.2%, P = 0.0011; 89.7% vs. 82.3%; P = 0.045, respectively). Among patients with Clavien–Dindo grade 2–4 complications, the 5-year OS and DSS rates in the CCIHigh group ( ≥ 32.15) were significantly lower than those in the CCILow group ( < 32.15; 47.5% vs. 74.9%, P = 0.0086; 63.1% vs. 90.0%, P = 0.0003). A multivariate analysis identified the CCI as an independent prognostic indicator in patients with Clavien–Dindo grade 2–4 complications.


The CCI was closely associated with the prognosis of patients with Clavien–Dindo grade 2–4 complications and may be a prognostic indicator.


Clavien–Dindo classification Comprehensive complication index Gastric cancer Prognosis 



We thank Edanz Group ( for editing a draft of this manuscript.


The authors received no grants, equipment or funding for this study.

Compliance with Ethical Standards

Conflict of interest

The authors declare no conflicts of interest in association with the present study.

Ethical approval

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


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Shota Shimizu
    • 1
  • Hiroaki Saito
    • 1
    Email author
  • Yusuke Kono
    • 1
  • Yuki Murakami
    • 1
  • Yuji Shishido
    • 1
  • Kozo Miyatani
    • 1
  • Tomoyuki Matsunaga
    • 1
  • Yoji Fukumoto
    • 1
  • Yoshiyuki Fujiwara
    • 1
  1. 1.Division of Surgical Oncology, Department of Surgery, School of MedicineTottori University Faculty of MedicineYonagoJapan

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