The Value Of Preoperative SIRI Combined With CONUT Score In Evaluating Prognosis Of Patients With Advanced Gastric Cancer

Objective:To explore the value of preoperative Systemic inflammatory response index（SIRI）combined with Controlling nutritional status（CONUT）score in evaluating prognosis of patients with advanced gastric cancer.Methods:A retrospective study of the clinicopathological and follow-up data of 188patients with advanced stage Ib to III gastric cancer who underwent radical gastrectomy in the General Surgery Department of Shaanxi Provincial People’s Hospital from January1,2015 to December 30,2017;Calculate the SIRI and CONUT scores,determine the best cut-off value of the preoperative SIRI and CONUT scores through the ROC curve,and group them separately.According to the separate grouping of the two,establish a joint scoring group（SIRI-CONUT score=0,1,2）;The relationship between the three groups and the clinicopathological characteristics,postoperative complications and prognosis was compared;To establish a prediction model and evaluation model for the prognosis of advanced gastric cancer based on SIRI-CONUT score.Results:The ROC curve analysis results showed that the best cutoff values of SIRI and CONUT scores were 0.77 and 3.5 respectively.The SIRI-CONUT score（0,1,2）was formed according to the cut-off value of SIRI and CONUT score.Comparison of the relationship between preoperative grouping of different SIRI-CONUT evaluation and clinicopathologic features,and comparison of the differences in the maximum diameter（x²=8.246,P=0.002）,T stage（x²=6.676,P=0.034）and vascular invasion（x²=6.854,P=0.031）of advanced gastric cancer tumor.There was statistical significance（P<0.05）.Complication analysis results,The difference in anastomotic leakage（x²=6.871,P=0.023）between different SIRI-CONUT scoring groups was statistically significant（P<0.05）;Univariate and multivariate analyses of postoperative complications were as follows:age（x²=8.445,P=0.002）,CCI（x²=4.270,P=0.039）,surgical method（x²=6.083,P=0.048）,vascular infiltration（x²=4.038,P=0.044）and SIRI-CONUT score（x²=7.861,P=0.012）were statistically significant（P<0.05）.Age≥65 years old（OR=2.684,95%CI:1.362-5.289）,total gastrectomy（OR=2.400,95%CI:1.222-4.716）,SIRI-CONUT score=2（OR=2.645,95%CI:1.325-5.282）were independent risk factors for postoperative complications of advanced gastric cancer,and the difference was statistically significant（P<0.05）.Single factor results showed that age≥65 years old,postoperative complications,maximum tumor diameter,T stage,N stage,TNM stage,vascular infiltration,CA199,SIRI-CONUT score were risk factors for the prognosis of advanced gastric cancer（P<0.05）.Multivariate COX regression analysis showed that age≥65 years old,maximum tumor diameter≥5cm,stage T_4b,stage N_2³,vascular infiltration and SIRI-CONUT score=2 were independent risk factors for prognosis of advanced gastric cancer（P<0.05）.The 5-year overall survival rate of patients in the SIRI-CONUT score=2 group was significantly lower than that in the SIRI-CONUT score=0 and 1 group,and the difference was significant（P<0.05）.The prediction model was established based on SIRI-CONUT score,age,stage T,stage N,maximum tumor diameter and vascular invasion,According to C-index and calibration curve,the prediction effect of the model was evaluated,C-index=0.809（95%CI:0.812-0.826,P<0.001）.The calibration curve of the model is close to the reference line（diagonal line）in predicting the OS rate of 1,3 and 5 years,and the model has a good prediction effect.Conclusion:Preoperative SIRI combined with CONUT score=2 was an independent risk factor for recent postoperative complications in advanced gastric cancer.Preoperative SIRI combined with CONUT score=2 independent risk factors for poor prognosis of advanced gastric cancer.The prediction model based on the histogram of SIRI-CONUT score,age,maximum tumor diameter,stage T,stage N and vascular infiltration has good value in predicting the prognosis of advanced gastric cancer.