Prognostic value of systemic immune-inflammation index in patients with gastric cancer

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Abstract

Background

Inflammation-based indexes have been used to predict survival and recurrence in cancer patients. Systemic immune-inflammation index (SII) was reported to be associated with prognosis in some malignant tumors. In the present study, we aimed to explore the association between SII and the prognosis of patients with gastric cancer.

Methods

We retrospectively analyzed data from 444 gastric cancer patients who underwent gastrectomy at the First Affiliated Hospital of Sun Yat-sen University between January 1994 and December 2005. Preoperative SII was calculated. The Chi square test or Fisher’s exact test was used to determine the relationship between preoperative SII and clinicopathologic characteristics. Overall survival (OS) rates were estimated using the Kaplan–Meier method, and the effect of SII on OS was analyzed using the Cox proportional hazards model. Receiver operating characteristic (ROC) curves were used to compare the predictive ability of SII, NLR, and PLR.

Results

SII equal to or higher than 660 was significantly associated with old age, large tumor size, unfavorable Borrmann classification, advanced tumor invasion, lymph node metastasis, distant metastasis, advanced TNM stage, and high carcino-embryonic antigen level, high neutrophil–lymphocyte ratio, and high platelet–lymphocyte ratio (all P < 0.05). High SII was significantly associated with unfavorable prognosis ( P < 0.001) and SII was an independent predictor for OS ( P = 0.015). Subgroups analysis further showed significant associations between high SII and short OS in stage I, II, III subgroups (all P < 0.05). SII was superior to NLR and PLR for predicting OS in patients with gastric cancer.

Conclusion

Preoperative SII level is an independent prognostic factor for OS in patients with gastric cancer.

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Most cited references 18

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Preoperative platelet lymphocyte ratio (PLR) is superior to neutrophil lymphocyte ratio (NLR) as a predictive factor in patients with esophageal squamous cell carcinoma

Ji-Feng Feng, Ying Huang, Qi-Xun Chen (2014)

Background Recent studies have shown that the presence of systemic inflammation correlates with poor survival in various cancers. The aim of this study was to determinate the prognostic value of the neutrophil lymphocyte ratio (NLR) and the platelet lymphocyte ratio (PLR) in patients with esophageal squamous cell carcinoma (ESCC). Methods Preoperative NLR and PLR were evaluated in 483 patients undergoing esophagectomy for ESCC from January 2005 to December 2008. The prognostic significance of both markers was then determined by both uni- and multivariate analytical methods. Receiver operating characteristic (ROC) curves were also plotted to verify the accuracy of NLR and PLR for survival prediction. Results High preoperative NLR (≥3.5 versus < 3.5, P = 0.039) and PLR (≥150 versus < 150, P < 0.001) were significantly associated with poor overall survival in multivariate analysis. However, our study demonstrated a better discrimination for the PLR in terms of hazard ratio(HR) than the NLR (HR = 1.840 versus HR = 1.339). Patients with NLR ≥3.5 had significantly poorer overall survival compared to NLR <3.5 (35.4% versus 57.7%, P < 0.001). Patients with PLR ≥150 also had significantly poorer overall survival compared to patients with PLR <150 (32.7% versus 63.5%, P < 0.001). The area under the curve (AUC) was 0.658 (95% confidence interval (CI): 0.610 to 0.706, P < 0.001) for NLR and 0.708 (95% CI: 0.662 to 0.754, P < 0.001) for PLR, indicating that PLR was superior to NLR as a predictive factor in ESCC. Conclusions Preoperative NLR and PLR were significant predictors of overall survival in patients with ESCC. However, PLR is superior to NLR as a predictive factor in patients with ESCC.

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Application of platelet/lymphocyte and neutrophil/lymphocyte ratios in early diagnosis and prognostic prediction in patients with resectable gastric cancer.

Lian Lian, You-You Xia, Chong Zhou … (2015)

Gastric cancer is the fourth most frequent cancer and the second cause of cancer-related deaths worldwide. China has a high incidence of gastric cancer. Inflammation is a critical component of tumor progression. It has been widely accepted that gastric cancer is an inflammation-driven cancer. In this study, we investigated the application value of systemic inflammatory response (SIR) markers, platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR), in early diagnosis and prognostic prediction in patients with resectable gastric cancer.

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Clinical evaluation of CEA, CA19-9, CA72-4 and CA125 in gastric cancer patients with neoadjuvant chemotherapy

Zhipeng Sun, Nengwei Zhang (2014)

Background In the clinical practice of neoadjuvant chemotherapy, response markers are very important. We aimed o investigate whether tumor markers CEA(carcino-embryonic antigen), CA19-9(carbohydrate antigen 19–9), CA72-4(carbohydrate antigen 72–4), and CA125(carbohydrate antigen 125) can be used to evaluate the response to neoadjuvant chemotherapy, and to evaluate the diagnosis and prognosis value of four tumor markers in the patients of gastric cancer. Methods A retrospective review was performed of 184 gastric cancer patients who underwent a 5-Fu, leucovorin, and oxaliplatin (FOLFOX) neoadjuvant chemotherapy regimen, followed by surgical treatment. Blood samples for CEA, CA19-9, CA72-4, and CA125 levels were taken from patients upon admission to the hospital and after neoadjuvant chemotherapy. Statistical analysis was performed to identify the clinical value of these tumor markers in predicting the survival and the response to neoadjuvant chemotherapy. Results Median overall survival times of pretreatment CA19-9-positive and CA72-4-positive patients (14.0 +/−2.8 months and 14.8 +/−4.0 months, respectively) were significantly less than negative patients (32.5 +/−8.9 months and 34.0 +/−10.1 months, respectively) (P = 0.000 and P = 0.002, respectively). Pretreatment status of CA19-9 and CA72-4 were independent prognostic factors in gastric cancer patients (P = 0.029 and P = 0.008, respectively). Pretreatment CEA >50 ng/ml had a positive prediction value for clinical disease progression after neoadjuvant chemotherapy according to the ROC curve (AUC: 0.694, 95% CI: 0.517 to 0.871, P = 0.017). The decrease of tumor markers CEA, CA72-4, and CA125 was significant after neoadjuvant chemotherapy (P = 0.030, P = 0.010, and P = 0.009, respectively), especially in patients with disease control (including complete, partial clinical response, and stable disease) (P = 0.012, P = 0.020, and P = 0.025, respectively). A decrease in CA72-4 by more than 70% had a positive prediction value for pathologic response to neoadjuvant chemotherapy according to the ROC curve (AUC: 0.764, 95% CI: 0.584 to 0.945, P = 0.020). Conclusions Our results suggest that high preoperative serum levels of CA72-4 and CA19-9 are associated with higher risk of death, high pretreatment CEA levels (>50 ng/ml) may predict clinical disease progression after neoadjuvant chemotherapy, and a decrease (>70%) of CA72-4 may predict pathologic response to neoadjuvant chemotherapy.

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Author and article information

Contributors

Kang Wang: wangk1992@foxmail.com

Feiyu Diao: diaofeiyu@126.com

Zhijun Ye: zhijunye@foxmail.com

Xinhua Zhang: Zhangxinhua2@medmail.com.cn

Ertao Zhai: Tao450000@163.com

Hui Ren: renner@126.com

Tong Li: litongsysu@163.com

Hui Wu: docwuhui@126.com

Yulong He: YLH@medmail.com.cn

Shirong Cai: Caisrteam@163.com

Jianhui Chen: slimmerchen@163.com

Journal

Journal ID (nlm-ta): Chin J Cancer

Journal ID (iso-abbrev): Chin J Cancer

Title: Chinese Journal of Cancer

Publisher: BioMed Central (London )

ISSN (Print): 1000-467X

ISSN (Electronic): 1944-446X

Publication date (Electronic): 12 September 2017

Publication date PMC-release: 12 September 2017

Publication date Collection: 2017

Volume: 36

Electronic Location Identifier: 75

Affiliations

[1 ]GRID grid.412615.5, Gastrointestinal Surgery Center, , The First Affiliated Hospital of Sun Yat-sen University, ; Guangzhou, 510080 Guangdong P. R. China

[2 ]ISNI 0000 0004 1791 7851, GRID grid.412536.7, Department of Gastrointestinal Surgery, , Sun Yat-sen Memorial Hospital of Sun Yat-sen University, ; Guangzhou, 512120 Guangdong P. R. China

[3 ]GRID grid.412615.5, Department of Gastroenterology and Hepatology, , The First Affiliated Hospital of Sun Yat-sen University, ; Guangzhou, 510080 Guangdong P. R. China

Article

Publisher ID: 243

DOI: 10.1186/s40880-017-0243-2

PMC ID: 5596912

PubMed ID: 28899420

SO-VID: 7c2b7d6e-2b7e-44b7-a1a3-20a2b5f3553b

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 20 April 2017

Date accepted : 4 September 2017

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Keywords: gastric cancer,preoperative systemic immune-inflammation index,prognosis

Data availability:

Keywords: gastric cancer, preoperative systemic immune-inflammation index, prognosis

Prognostic value of systemic immune-inflammation index in patients with gastric cancer

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Karger: Oncology

Most cited references 18

Preoperative platelet lymphocyte ratio (PLR) is superior to neutrophil lymphocyte ratio (NLR) as a predictive factor in patients with esophageal squamous cell carcinoma

Application of platelet/lymphocyte and neutrophil/lymphocyte ratios in early diagnosis and prognostic prediction in patients with resectable gastric cancer.

Clinical evaluation of CEA, CA19-9, CA72-4 and CA125 in gastric cancer patients with neoadjuvant chemotherapy

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