Published online Apr 15, 2022. doi: 10.4251/wjgo.v14.i4.897
Peer-review started: August 7, 2021
First decision: October 3, 2021
Revised: October 8, 2021
Accepted: February 22, 2022
Article in press: February 22, 2022
Published online: April 15, 2022
Gastric cancer (GC) is an important public health burden worldwide. In East Asia, the tumor infiltrative pattern (INF) has gradually become a clinicopathologic feature routinely evaluated in surgically resected specimens. The INF type categorizes GC as the expansive growth type (INFa), the intermediate type (INFb), and the infiltrative growth type (INFc). Different INF types differ in clinicopathological features and prognosis and can be used as predictors of postoperative recurrence and prognosis in GC patients. Many studies have shown that inflammatory indices are potential prognostic indices for GC patients. However, there is no evidence defining the prognostic significance of immune inflammatory indices for GC with different INF types.
Evaluating whether inflammatory indices have prognostic significance for GC with different INF types will provide a basis for clinicians to treat and predict the prognosis of these patients in the future.
To analyze the relationships among peripheral circulating immune cells, inflammatory indices and INF types and to evaluate their ability to evaluate the outcome of patients with GC.
This retrospective study analyzed the clinicopathological characteristics and long-term survival data of 962 patients who underwent radical gastrectomy. Patients were categorized into the INFa, INFb, and INFc groups. The differences of clinicopathological features between the three groups were analyzed by chi-square test. The cutoff values of inflammatory indices were analyzed by receiver operating characteristic curves. The Kaplan–Meier and log-rank tests were used to analyze overall survival (OS). The independent risk factors for patients prognosis were analyzed by univariate and multivariate analyses based on the logistic regression. The nomogram models were constructed by R studio.
Based on the postoperative pathology report, there were 183, 331 and 448 patients in the INFa, INFb, and INFc groups, respectively. The OS of the INFc group was significantly lower than that of the other two groups (P < 0.001). The systemic immune-inflammation index (P = 0.039) and metastatic lymph node ratio (mLNR) (P = 0.003) were independent risk factors for prognosis in the INFa group. The platelet–lymphocyte ratio (PLR) (P = 0.018), age (P = 0.026), body mass index (P = 0.003), and postsurgical tumor node metastasis (pTNM) stage (P < 0.001) were independent risk factors for prognosis in the INFb group. The PLR (P = 0.021), age (P = 0.021), pTNM stage (P = 0.028), and mLNR (P = 0.002) were independent risk factors for prognosis in the INFc group. The area under the curve of the nomogram model for predicting 5-year survival in the INFa group, INFb group, and INFc group was 0.787, 0.823, and 0.781, respectively.
The nomogram model based on different inflammatory indices and clinicopathological features can be used to evaluate the prognosis of different INF types GC patients.
Further multicentric studies are needed to expansion of the sample size and external validation of nomogram model was performed to determine its predictive ability.