| Background Age,comorbidities and systemic inflammation have been shown to be closely related to the prognosis of several tumors.However,the correlation between the Age-Adjusted Charlson Comorbidity Index(ACCI)and systemic inflammation in patients with gastric cancer(GC)and their co-effect on prognosis have not been reported.Objective To examine the associations of the ACCI and preoperative systemic inflammation with survival in GC patients who underwent radical gastrectomy.Methods Data from patients with GC who underwent radical gastrectomy between January 2009 and December 2014 in Fujian Medical University Union Hospital were retrospectively analyzed.Univariate and multivariate Cox regression analyses were performed to identify the prognostic factors.The relationship between the ACCI and systemic inflflammation of the patients was explored,and a new scoring system based on the ACCI and systemic inflammation(ANLR)was established.The Harrell’s C-statistics(C-index)and time-dependent receiver operating characteristic(t-ROC)curves were used to compare the predictive ability of different prognostic models.Results A total of 2257 patients with GC were included.The median follow-up period was 50 months(IQR: 31-71 months).The univariate Cox regression analysis revealed that ACCI and preoperative systemic makers including the neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)and lymphocyte to monocyte ratio(LMR)were closely related to prognosis.The ACCI and NLR were independent prognostic factors for overall survival(both P<0.001)by multivariate analysis.A higher ACCI and NLR(NLR≥3.0)were strongly associated with poor prognosis(P<0.05).ACCI was an independent predictor of a higher preoperative NLR(P<0.001).Based on the co-effect of the preoperative ACCI and NLR on overall survival(OS),we established a novel marker,ANLR.According to ANLR,the patients were further divided into three groups.There were 737 patients in the low ANLR group(32.6%),704 patients in the intermediate ANLR group(31.2%),and 816 patients in the high ANLR group(36.2%).The relationship between the ANLR and clinicopathological data was compared.The high ANLR group was dominated by patients with higher ASA scores,larger tumor sizes,and more advanced staging,and patients who were prone to lymphovascular invasion(all P<0.05).Kaplan-Meier curves showed significant differences in the 5-year OS among the three ANLR groups(the 5-year OS: low ANLR group: 75.2%,intermediate ANLR group: 67.9%,high ANLR group:55.6%,log-rank test: P<0.001).Multivariate analysis showed that the ANLR was a signifificant independent predictor of 5-year OS(P<0.001).We further compared the predictive accuracy of the model combining the ANLR and p TNM staging with that containing p TNM staging only for prediction of OS by establishing the time-ROC curves.The results showed that the prognostic model incorporating the ANLR and p TNM was superior to the model with simple p TNM staging during the follow-up period.The C-index of the model combining the ANLR with p TNM was 0.744(95% CI:0.728-0.760),which was significantly higher than the model with only the p TNM stage(0.717,95% CI: 0.702-0.731;P<0.001).The clinical performance of the combination of the ANLR and p TNM exceeded that of p TNM staging alone.Conclusion The ACCI of patients with gastric cancer was associated with preoperative systemic inflammation.ACCI and NLR were independent risk factors for long-term prognosis of patients with GC.And the combination of these two indicators could be considered a supplement to the traditional staging system to improve the prognosis evaluation of GC patients and guide individualized treatment strategies. |
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