Abstract
Background The systemic immune-inflammation index (SII), based on peripheral lymphocytes, neutrophils, and platelet count, has been used as a prognostic marker for several tumors. However, use of the SII has not been reported for gastric cancer. Methods We evaluated the prognostic value of the SII in primary and validation cohorts. We also established an effective prognostic nomogram for gastric cancer based on R language. The predictive accuracy and discriminative ability of the nomogram were determined using the concordance index (C index) and a calibration curve and were compared with TNM classifications. Results The Kaplan-Meier survival analysis results showed that the high SII was associated with poor prognosis of gastric cancer patients in the primary and validation cohorts. SII proved to be related to tumor location, histological grade, tumor size, TNM stage, and perineural infiltration in patients with gastric cancer and was an independent prognostic factor for patients with gastric cancer. SII has a better predictive ability than other existing prognostic indexes based on inflammation, such as NLR, PLR, and MLR. The nomogram established can accurately predict the 3- and 5-year survival rates of patients with gastric cancer after operation, and its accuracy is significantly higher than that of the 8th edition of the AJCC staging system. Conclusion SII can independently predict the overall survival of patients with gastric cancer after operation, which is superior to the existing systemic inflammatory indexes. The prognostic nomogram based on SII is a reliable model for predicting the postoperative survival of patients with gastric cancer.
Highlights
Gastric cancer is the fifth most common malignant tumor and the third leading cause of cancer death in the world and has become a major global health problem due to high morbidity and mortality [1, 2]
The KaplanMeier survival analysis revealed that gastric cancer patients with high systemic immune-inflammation index (SII), plateletlymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and monocyte-lymphocyte ratio (MLR) scores had poor prognosis (Figures 1(a)–1(d)), but the counts for neutrophils, lymphocytes, platelets, and monocyte alone showed no significant influences on prognosis
SII, PLR, NLR, and MLR were factors affecting prognosis, while gender, age, Lauren type, vascular infiltration, and postoperative adjuvant chemotherapy had no significant influences on prognosis (Table 3)
Summary
Gastric cancer is the fifth most common malignant tumor and the third leading cause of cancer death in the world and has become a major global health problem due to high morbidity and mortality [1, 2]. To reduce the risk of postoperative recurrence and metastasis, early diagnosis and developing an appropriate treatment plan based on the expected survival time of patients will help improve the cure rate of gastric cancer and the survival quality of patients. Clinicians mainly evaluate the prognosis of patients with gastric cancer according to the 8th edition of the American Joint Committee on Cancer tumor node metastasis (AJCC-TNM) staging system. The prognosis of patients with gastric cancer within the same TNM stage is usually different after receiving similar treatment [6]. Further studies are needed to identify new tumor markers with high specificity and sensitivity in gastric cancer and to distinguish patient subgroups with a high risk of recurrence and metastasis to accurately predict the prognosis of patients with gastric cancer and determine the optimal therapeutic strategy. Use of the SII has not been reported for gastric cancer
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