Research Papers:

Novel inflammation-combined prognostic index to predict survival outcomes in patients with gastric cancer

Noriyuki Hirahara _, Takeshi Matsubara, Shunsuke Kaji, Hikota Hayashi, Yohei Sasaki, Koki Kawakami, Ryoji Hyakudomi, Tetsu Yamamoto and Yoshitsugu Tajima

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Oncotarget. 2023; 14:71-82. https://doi.org/10.18632/oncotarget.28353

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Noriyuki Hirahara1, Takeshi Matsubara1, Shunsuke Kaji2, Hikota Hayashi1, Yohei Sasaki3, Koki Kawakami2, Ryoji Hyakudomi1, Tetsu Yamamoto1 and Yoshitsugu Tajima1

1 Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan

2 Department of Surgery, Matsue Red Cross Hospital, Matsue, Shimane 690-0886, Japan

3 Department of Surgery, Masuda Red Cross Hospital, Masuda, Shimane 698-8501, Japan

Correspondence to:

Noriyuki Hirahara, email: [email protected]

Keywords: gastric cancer; laparoscopic gastrectomy; novel predictive index; inflammation-combined prognostic index; cancer-specific survival

Received: December 15, 2022     Accepted: January 16, 2023     Published: January 31, 2023

Copyright: © 2023 Hirahara et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Background: We focused on the lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) and devised an inflammation-combined prognostic index (ICPI) as a prognostic marker of cancer-specific survival (CSS).

Methods: We reviewed the clinicopathological data of 480 patients with gastric cancer undergoing curative laparoscopic gastrectomy between 2009 and 2019. This study examined the significance of LMR, NLR, PLR, and ICPI as cancer-specific prognostic markers.

Results: In univariate analysis, tumor diameter, histological differentiation, pathological tumor-node-metastasis (pTNM) stage, LMR, NLR, PLR, C-reactive protein (CRP) level, carcinoembryonic antigen (CEA), and postoperative chemotherapy were significantly associated with CSS. In multivariate analysis, pTNM stage and CEA were the independent risk factors for CSS, although LMR, NLR, and PLR were not the independent risk factors for CSS.

The ICPI formula was constructed using hazard ratios for three inflammation-based biomarkers with worse prognosis identified in the univariate analysis: LMR <4.315, NLR ≥2.344, and PLR ≥212.01, which were each scored as 1, with all remaining values pointed at 0. ICPI was calculated as follows: ICPI = 2.9 × LMR + 2.8 × NLR + 2.8 × PLR. The optimal cutoff value of ICPII was 2.9. On multivariate analysis, pTNM stage, CEA, and ICPI were independent prognostic factors for CSS. In the Kaplan–Meier survival analysis, CSS in the high ICPI group was significantly worse than that in the low ICPI group.

Conclusion: ICPI was devised as a novel predictive index for prognosis, and its usefulness was clarified.

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