Abstract
Several studies have demonstrated that diverse systemic inflammatory-based prognostic parameters predict a poor prognosis in patients with gastric cancer. However, few studies have focused on the relationships between postoperative complications and systemic inflammatory-based prognostic parameters after curative gastrectomy. We investigated the relationships between postoperative complications and these parameters and assessed the clinical utility of the parameters as predictors of postoperative complications in patients with stage I-III gastric cancer. We retrospectively reviewed 300 patients who underwent curative gastrectomy for stage I-III gastric cancer. All postoperative complications were classified as infectious or noninfectious. We evaluated the relationships between postoperative complications and clinical factors, including systemic inflammatory-based prognostic parameters. In total, 101 patients (33.7%) had postoperative Clavien-Dindo grade II-IV complications, and 54 (18.0%) patients developed infectious complications including pancreatic fistula, pneumonia, anastomotic leak, intra-abdominal abscess, and cholecystitis. The relationships between postoperative complications and systemic inflammatory-based prognostic parameters were evaluated by the areas under the receiver operating characteristic curves. Postoperative pneumonia was identified as the most sensitive complication to the systemic inflammatory-based prognostic parameters. Multivariate analysis revealed that preoperative neutrophil-to-lymphocyte ratio (odds ratio, 14.621; 95% confidence interval, 1.160-184.348; p = 0.038) was an independent predictor of pneumonia. Preoperative neutrophil-to-lymphocyte ratio may be a useful predictor of postoperative pneumonia in patients with stage I-III gastric cancer after curative gastrectomy.
Highlights
Several studies have demonstrated that diverse systemic inflammatory-based prognostic parameters predict poor prognosis in patients with gastric cancer
One hundred thirty-five patients, 74 patients, or 91 patients were diagnosed with pathological stage I, II, or III gastric cancer (GC), respectively
The relationships between all postoperative complications and the prognosis of stage I–III GC patients were assessed, and we identified a significant difference between patients with and without any postoperative complication regarding Overall survival (OS) (P=0.002) and relapse-free survival (RFS) (P=0.013) (Fig. 2a and b)
Summary
Several studies have demonstrated that diverse systemic inflammatory-based prognostic parameters predict poor prognosis in patients with gastric cancer. Few studies focused on the relationships between postoperative complications and systemic inflammatory-based prognostic parameters after curative gastrectomy. We investigated the relationships between postoperative complications and these parameters to identify parameter-specific postoperative complications, and assessed the clinical utility of the parameters as predictors of postoperative complications in stage I–III gastric cancer patients. Systemic inflammatory-based prognostic parameters, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), prognostic nutrition index (PNI), and C-reactive protein-to-albumin ratio (CAR) are well-known predictors of poor prognosis in GC patients [11,12,13,14,15,16]. Okugawa et al [18] identified lymphocyte-to-C-reactive protein ratio (LCR) before surgery as a promising new marker for surgical and oncological outcomes in stage
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