Retrospective Study
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World J Gastrointest Oncol. Apr 15, 2022; 14(4): 897-919
Published online Apr 15, 2022. doi: 10.4251/wjgo.v14.i4.897
Prognostic significance of serum inflammation indices for different tumor infiltrative pattern types of gastric cancer
Yu-Fei Wang, Xin Yin, Tian-Yi Fang, Yi-Min Wang, Lei Zhang, Xing-Hai Zhang, Dao-Xu Zhang, Yao Zhang, Xi-Bo Wang, Hao Wang, Ying-Wei Xue
Yu-Fei Wang, Xin Yin, Tian-Yi Fang, Yi-Min Wang, Dao-Xu Zhang, Yao Zhang, Xi-Bo Wang, Hao Wang, Ying-Wei Xue, Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
Lei Zhang, Xing-Hai Zhang, Department of Pathology, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
Author contributions: Wang YF and Yin X designed and conceived this project, and they contributed equally to this work; Wang YF, Yin X, Fang TY and Wang YM, Zhang L, Zhang XH interpreted and analyzed the data; Xue YW revised the manuscript for important intellectual content; Wang YF, Yin X, Fang TY, Wang YM, Zhang L, Zhang XH, Zhang DX, Zhang Y, Wang XB, Wang H participated in the patient information collection; all authors read and approved the final manuscript.
Supported by the Harbin Science and Technology Bureau Research and Development Project of Applied Technology, No. 2017RAXXJ054; and Nn 10 Program of Harbin Medical University Cancer Hospital, No. Nn 10 PY 2017-03.
Institutional review board statement: The study was approved by the Ethics Committee of the Affiliated Tumor Hospital of Harbin Medical University.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: Patients’ data were saved in the Gastric Cancer Information Management System v1.2 of Harbin Medical University Cancer Hospital (Copyright No. 2013SR087424, http://www.sgihmu.com).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying-Wei Xue, PhD, Chief Doctor, Professor, Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, No. 150 Haping Road, Harbin 150081, Heilongjiang Province, China. xueyingwei@hrbmu.edu.cn
Received: August 7, 2021
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
Processing time: 251 Days and 5.7 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

The nomogram model based on different inflammatory indices and clinicopathological features can be used to evaluate the prognosis of different INF types GC patients.

Research perspectives

Further multicentric studies are needed to expansion of the sample size and external validation of nomogram model was performed to determine its predictive ability.