Prognostic Importance Of The Preoperative Modified Systemic Inflammation Score For Patients With Gastric Cancer

Background 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 clear-cell renal cell carcinoma and colorectal cancer.However,the utility of the SIS in gastric cancer(GC)remains unclear.Objective To investigate the prognostic value of the SIS in patients with resectable GC and propose a modified systemic inflammation score(mSIS).Methods The study involved 1786 GC patients who underwent curative resection between December 2008 to December 2013.The optimal cutoff values for continuous inflammation-based prognostic variables were calculated by the software X-tile.Cox proportional hazards models were used to evaluate the association between variables and prognosis.Time-dependent receiver operating characteristics analysis(t-ROC),concordance index(C-index)and the estimated area under the curve(AUC)were used to compare the prognostic impact.Results In all,1810 patients with resectable GC were included in the study.The median patient age at the time of surgery was 61 years(interquartile range(IQR): 55–69 years).The optimal cutoff value of LMR was 3.4 determined by the software X-tile.By multivariate analysis,the SIS was not an independent prognostic factor(P>0.05).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).In a subgroup analysis according to TNM stage,the mSIS clearly stratified the survival rate for each stage(all P<0.05).The t-ROC curve and C-index(0.616 vs.0.597)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).In multivariate subgroup analysis of 239 patients with Glasgow Prognostic Score(GPS),mSIS remained the only independently significant biomarker(P<0.05).In addition,the t-ROC curve and C-index(0.636 vs.0.567)for the mSIS were superior to those of the GPS throughout the observation period.Conclusion 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.