Combining systemic inflammatory response index and albumin fibrinogen ratio to predict early serious complications and prognosis after resectable gastric cancer

doi:10.4251/wjgo.v16.i3.732

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World Journal of Gastrointestinal Oncology

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Retrospective Cohort Study

World J Gastrointest Oncol. Mar 15, 2024; 16(3): 732-749
Published online Mar 15, 2024. doi: 10.4251/wjgo.v16.i3.732

Table 1 Occurrence of short-term postoperative complications in patients after radical gastrectomy

Postoperative complications	n (%)
Enteral nutrition time > 2 wk	26 (4.58)
Incision infection	4 (0.70)
Abdominal infection	160 (28.17)
Pulmonary infection	70 (12.32)
Pelvic effusion	6 (1.06)
Abdominal bleeding	9 (1.58)
Anastomotic fistula	6 (1.06)
Pyloric or intestinal obstruction	14 (2.46)
Deep venous thrombosis	10 (1.76)
Splenic embolism	1 (0.18)
Pulmonary embolism	4 (0.70)
Shock	7 (1.23)

Table 2 Patient baseline characteristics and differences in each variable across subgroups of postoperative complications after respectable gastric cancer

Variables		Minor/no complication, n = 479 (84.3%)	Major complication, n = 89 (15.7%)	P value
Variables		Minor/no complication, n = 479 (84.3%)	Major complication, n = 89 (15.7%)	P value	Sex
Male	378 (78.9)	64 (71.9)	0.144¹		Sex
Female	101 (21.1)	25 (28.1)
Age in yr		59.93 ± 9.66	62.19 ± 10.33	0.046²^,^a
Underlying disease	No	382 (79.7)	75 (84.3)	0.323¹
Underlying disease	Yes	97 (20.3)	14 (15.7)
BMI		22.37 ± 3.36	21.23 ± 3.28	0.003²^,^a
Tumor location	Upper third	56 (11.7)	15 (16.9)	0.537¹
	Middle third	44 (9.2)	8 (9.0)
	Lower third	377 (78.7)	66 (74.2)
Tumor dimensions in cm	< 3	148 (30.9)	16 (18.0)	0.014¹^,^a
Tumor dimensions in cm	≥ 3	331 (69.1)	73 (82.0)
Differentiation	Moderate and poor	460 (96.0)	86 (96.6)	1¹
Differentiation	Well	19 (4.0)	3 (3.4)
TNM stage	I	106 (22.1)	13 (14.6)	0.236¹
	II	150 (31.3)	28 (31.5)
	III	223 (46.6)	48 (53.9)
Surgical approach	Open	149 (31.1)	31 (34.8)	0.539¹
	Laparoscopic	190 (39.7)	37 (41.6)
	Robot-assisted	140 (29.2)	21 (23.6)
Operation	Subtotal gastrectomy	248 (51.8)	34 (38.2)	0.019¹^,^a
Operation	Total gastrectomy	231 (48.2)	55 (61.8)
ASA	I-II	433 (90.4)	76 (85.4)	0.155¹
ASA	III-IV	46 (9.6)	13 (14.6)
Blood loss in mL		100 (100)	150 (200)	0.089³
Duration of surgery in min		240 (90)	250 (85)	0.079³
Perioperative transfusion	No	389 (81.2)	50 (56.2)	< 0.001¹^,^a
Perioperative transfusion	Yes	90 (18.8)	39 (43.8)
Length of hospitalization in d		17.00 (5.00)	21.00 (8.00)	< 0.001³^,^a
Lymph node metastasis rate, %		4.02% ± 15.17%	4.52% ± 14.72%	0.264²
Lymphocytes as × 10⁹/L		1.44 (0.72)	1.18 (0.59)	< 0.001³^,^a
Neutrophils as × 10⁹/L		3.52 (1.76)	5.03 (1.56)	< 0.001³^,^a
Platelet as × 10⁹/L		213 (86)	234 (107)	0.013³^,^a
Monocyte as × 10⁹/L		0.39 (0.16)	0.42 (0.17)	0.032³^,^a
Albumin in g/L		39.40 ± 4.36	36.60 ± 4.50	< 0.001²^,^a
Fibrinogen in g/L		3.39 ± 0.79	4.08 ± 1.04	< 0.001²^,^a
SIRI		0.95 (0.82)	1.54 (0.97)	< 0.001³^,^a
AFR		12.32 ± 3.46	9.54 ± 2.68	< 0.001³^,^a
CA199 in ng/mL	Negative	406 (84.8)	69 (77.5)	0.090¹
	Positive	73 (15.2)	20 (22.5)
CEA in ng/mL	Negative	386 (80.6)	61 (68.5)	0.011¹^,^a
	Positive	93 (19.4)	28 (31.5)

^aP < 0.05.

¹χ² test.

²Student’s t-test with mean ± standard deviation.

³Mann-Whitney U test with median (interquartile range).

AFR: Albumin fibrinogen ratio; ASA: American Society of Anesthesiology; BMI: Body mass index; CA199: Carbohydrate antigen 199; CEA: Carcinoembryonic antigen; SIRI: Systemic inflammation response index; TNM: Tumor-node-metastasis.

Table 3 Differences in preoperative systemic inflammation response index and albumin fibrinogen ratio at varying levels of clinicopathological variables in gastric cancer patients

Variables		Preoperative SIRI, median (IQR)	¹P value	Preoperative AFR, mean ± SD	²P value
Sex	Male	1.11 (0.89)	0.002^a	11.96 ± 3.68	0.252
	Female	0.91 (0.87)		11.62 ± 2.77
Age in yr	< 60	1.03 (0.86)	0.038^a	12.58 ± 3.83	< 0.001^a
	≥ 60	1.14 (0.96)		11.26 ± 3.04
Underlying disease	No	1.07 (0.90)	0.187	11.88 ± 3.55	0.989
	Yes	1.14 (0.91)		11.89 ± 3.31
BMI	< 24	1.06 (0.89)	0.29	11.82 ± 3.60	0.464
	≥ 24	1.15 (0.85)		12.06 ± 3.23
Tumor location	Upper third	1.17 (1.09)	0.164	11.63 ± 3.09	0.695
	Middle third	1.00 (0.80)		12.36 ± 3.14
	Lower third	1.07 (0.88)		11.88 ± 3.61
Tumor dimensions in cm	< 3	0.89 (0.69)	< 0.001^a	13.44 ± 3.86	< 0.001^a
	≥ 3	1.17 (0.92)		11.26 ± 3.13
Differentiation	Moderate and poor	1.08 (0.90)	0.235	11.80 ± 3.46	0.002
	Well	0.91 (0.71)		14.11 ± 3.90
TNM stage	I	0.78 (0.58)	< 0.001^a	13.70 ± 4.20	< 0.001^a
	II	1.08 (0.93)		11.66 ± 3.41
	III	1.20 (0.92)		11.24 ± 2.90
Surgical approach	Open	1.16 (0.89)	0.261	12.05 ± 3.97	0.617
	Laparoscopic	1.05 (0.87)		11.90 ± 3.29
	Robot-assisted	1.08 (0.97)		11.68 ± 3.22
Operation	Subtotal gastrectomy	0.97 (0.84)	0.008^a	12.10 ± 3.41	0.169
	Total gastrectomy	1.15 (0.94)		11.67 ± 3.58
ASA	I-II	1.07 (0.90)	0.458	11.89 ± 3.53	0.906
	III-IV	1.23 (0.85)		11.83 ± 3.24
Perioperative transfusion	No	1.02 (0.81)	< 0.001^a	12.37 ± 3.50	< 0.001^a
	Yes	1.44 (1.20)		10.25 ± 3.00
CA199 in ng/mL	Negative	1.06 (0.86)	0.023^a	12.14 ± 3.16	0.001^a
	Positive	1.23 (1.17)		10.57 ± 2.83
CEA in ng/mL	Negative	1.03 (0.83)	< 0.001^a	12.24 ± 3.59	< 0.001^a
	Positive	1.29 (1.30)		10.58 ± 2.81
Blood loss in mL	< 200	1.02 (0.77)	0.011^a	12.24 ± 3.63	0.013^a
	200 ≤ X ≤ 400	1.16 (1.02)		11.49 ± 3.32
	> 400	1.25 (0.95)		11.00 ± 3.00
Relapse or metastasis	No	0.93 (0.82)	< 0.001^a	12.65 ± 3.35	< 0.001^a
	Yes	1.48 (1.07)		9.40 ± 2.77
P53	Wild	1.14 (0.94)	0.372	11.89 ± 3.40	0.997
	Mutant	1.06 (0.82)		11.89 ± 3.56
Ki-67	0%-49%	0.92 (0.79)	0.183	12.58 ± 3.16	0.249
	50%-74%	1.14 (0.79)		11.87 ± 3.30
	75%-100%	1.07 (0.95)		11.76 ± 3.66
Her-2	Negative	1.08 (0.91)	0.795	11.88 ± 3.53	0.891
	Positive	0.98 (0.75)		11.95 ± 3.19
Lymph node metastasis rate, %	< 4.60%	1.07 (0.90)	0.471	11.95 ± 3.55	0.112
	≥ 4.60%	1.20 (0.83)		11.10 ± 2.81
Enteral nutrition time	≤ 7 d	1.06 (0.91)	0.087	12.18 ± 3.62	0.01^a
	> 7 d	1.15 (0.88)		11.40 ± 3.23

^aP < 0.05.

¹P value using Mann-Whitney U test with median (interquartile range).

²P value using Student’s t-test with mean ± standard deviation.

AFR: Albumin fibrinogen ratio; ASA: American Society of Anesthesiology; BMI: Body mass index; CA199: Carbohydrate antigen 199; CEA: Carcinoembryonic antigen; IQR: Interquartile range; SD: Standard deviation; SIRI: Systemic inflammation response index; TNM: Tumor-node-metastasis.

Table 4 Univariate and multivariate analyses of the logistic regression model for postoperative complications in patients with gastric cancer

Variables	Univariate analysis			Multivariate analysis
Variables	OR	95%CI	P value	OR	95%CI	P value
Age in yr	1.025	1.000-1.049	0.046^a	1.011	0.984-1.040	0.427
BMI	0.896	0.832-0.964	0.003^a	0.939	0.864-1.020	0.135
Tumor dimensions in cm	2.04	1.148-3.624	0.015^a	0.869	0.443-1.706	0.684
Operation	1.737	1.092-2.761	0.02^a	1.619	0.944-2.777	0.080
Perioperative transfusion	3.371	2.091-5.434	< 0.001^a	2.095	1.179-3.722	0.012
CEA in ng/mL	1.905	1.154-3.146	0.012^a	1.268	0.711-2.262	0.421
Neutrophil count	1.413	1.240-1.609	< 0.001^a	2.036	1.240-1.609	< 0.001^a
Monocyte count	4.092	1.005-16.663	0.049^a	10.259	0.672-16.609	0.086
Lymphocyte count	0.381	0.232-0.626	< 0.001^a	0.161	0.053-0.493	0.001^a
Albumin	0.876	0.833-0.921	< 0.001^a	0.956	0.898-1.017	0.152
Fibrinogen	2.328	0.833-0.921	< 0.001^a	1.808	1.341-2.439	< 0.001^a
SIRI	1.429	1.790-3.027	< 0.001^a	1.221	1.031-1.446	0.018^a
AFR	0.729	0.665-0.799	< 0.001^a	0.761	0.693-0.843	< 0.001^a

^aP < 0.05.

AFR: Albumin fibrinogen ratio; BMI: Body mass index; CEA: Carcinoembryonic antigen; CI: Confidence interval; OR: Odds ratio; SIRI: Systemic inflammation response index.

Table 5 Univariate and multivariate Cox regression analysis for overall survival in gastric cancer patients

Variables		Univariate analysis			Multivariate analysis
Variables		HR	95%CI	P value	HR	95%CI	P value
Age in yr		1.024	1.005-1.043	0.013^a	1.000	0.981-1.020	0.964
Tumor dimensions in cm
	< 3/≥ 3	3.143	1.932-5.112	< 0.001^a	1.335	0.778-2.290	0.294
Differentiation
	Moderate and poor/well	0.144	0.020-1.029	0.053	0.605	0.073-5.026	0.641
Her-2	Negative/positive	0.504	0.206-1.231	0.133	0.583	0.230-1.479	0.256
TNM stage				< 0.001^a			< 0.001^a
	I	Ref			Ref
	II	3.550	1.570-8.027	0.002^a	1.777	0.665-4.748	0.479
	III	7.097	3.290-15.306	< 0.001^a	5.464	1.948-15.327	0.001^a
Operation time in min		1.003	1.001-1.006	0.003^a	1.003	1.000-1.005	0.055
Perioperative transfusion	No/yes	2.564	1.811-3.629	< 0.001^a	1.517	1.011-2.277	0.044^a
CA199 in ng/mL	Negative/positive	1.990	1.347-2.940	0.001^a	1.184	0.776-1.807	0.433
CEA in ng/mL	Negative/positive	2.126	1.490-3.034	< 0.001^a	1.605	1.101-2.338	0.014^a
Lymph node metastasis rate, %		1.001	0.991-1.012	0.790	0.990	0.979-1.002	0.110
Postoperative complication	No or minor/major	3.498	2.434-5.029	< 0.001^a	1.450	0.956-2.200	0.080
Postoperative chemotherapy	No/yes	1.916	1.239-2.963	0.003^a	0.628	0.357-1.104	0.106
Lymphocytes as × 10⁹/L		0.490	0.347-0.692	< 0.001^a	0.840	0.553-1.1275	0.413
Neutrophils as × 10⁹/L		1.240	1.152-1.335	< 0.001^a	1.075	0.357-1.104	0.106
Monocyte as × 10⁹/L		7.393	2.685-20.351	< 0.001^a	0.762	0.188-3.086	0.703
Albumin in g/L		0.880	0.850-0.911	< 0.001^a	0.969	0.927-1.013	0.164
Fibrinogen in g/L		2.063	1.792-2.375	< 0.001^a	1.415	1.111-1.803	0.005^a
SIRI		1.190	1.117-1.267	< 0.001^a	1.036	0.764-1.404	0.820
AFR		0.727	0.681-0.776	< 0.001^a	1.059	0.858-1.308	0.592
SIRI-AFR score							< 0.001^a
	0	Ref			Ref
	1	6.034	2.964-12.285	< 0.001^a	3.134	1.445-6.797	0.004^a
	2	20.555	10.287-41.071	< 0.001^a	5.239	2.122-12.935	< 0.001^a

^aP < 0.05.

AFR: Albumin fibrinogen ratio; CA199: Carbohydrate antigen 199; CEA: Carcinoembryonic antigen; CI: Confidence interval; OR: Odds ratio; SIRI: Systemic inflammation response index; TNM: Tumor-node-metastasis.

Table 6 Univariate and multivariate Cox regression analysis for disease-free survival in gastric cancer patients

Variables		Univariate analysis			Multivariate analysis
Variables		HR	95%CI	P value	HR	95%CI	P value
Age in yr		1.026	1.009-1.043	0.003^a	1.005	0.988-1.022	0.589
Tumor dimensions in cm	< 3/≥ 3	2.679	1.772-4.051	< 0.001^a	1.165	0.736-1.844	0.514
Differentiation	Moderate and poor/well	0.241	0.060-0.974	0.046^a	0.674	0.48-3.056	0.609
Her-2	Negative/positive	2.151	0.247-1.123	0.097	0.563	0.258-1.229	0.149
TNM stage				< 0.001^a			< 0.001^a
	I	Ref			Ref
	II	2.920	1.546-5.512	0.001^a	1.726	0.774-3.850	0.182
	III	5.167	2.844-9.387	< 0.001^a	4.071	1.757-9.435	0.001^a
Operation time in min		1.003	1.001-1.005	0.014^a	1.002	0.999-1.004	0.201
Perioperative transfusion	No/yes	2.288	1.666-3.141	< 0.001^a	1.377	0.954-1.989	0.088
CA199 in ng/mL	Negative/positive	1.852	1.292-2.653	0.001^a	1.251	0.851-1.838	0.255
CEA in ng/mL	Negative/positive	1.780	1.280-2.476	0.001^a	1.234	0.875-1.741	0.231
Lymph node metastasis rate, %		0.998	0.988-1.008	0.698	0.993	0.982-1.005	0.238
Postoperative complication	No or minor/major	3.980	2.895-5.470	< 0.001^a	1.604	1.115-2.307	0.011^a
Postoperative chemotherapy	No/yes	1.836	1.248-2.702	0.002^a	0.609	0.365-1.018	0.059
Lymphocytes as × 10⁹/L		0.515	0.378-0.703	< 0.001^a	0.954	0.669-1.359	0.792
Neutrophils as × 10⁹/L		1.192	1.119-1.269	< 0.001^a	1.036	0.938-1.144	0.484
Monocyte as × 10⁹/L		5.946	2.457-14.387	< 0.001^a	0.980	0.301-3.188	0.973
Albumin in g/L		0.884	0.857-0.912	< 0.001^a	0.959	0.920-0.999	0.044^a
Fibrinogen in g/L		2.141	1.867-2.456	< 0.001^a	1.407	1.126-1.759	0.003^a
SIRI		1.142	1.080-1.207	< 0.001^a	1.076	0.913-1.268	0.380
AFR		0.735	0.692-0.780	< 0.001^a	0.931	0.700-1.239	0.625
SIRI-AFR score							< 0.001^a
	0	Ref			Ref
	1	6.042	3.339-10.931	< 0.001^a	3.543	1.844-6.809	< 0.001^a
	2	18.207	10.138-32.699	< 0.001^a	5.005	2.256-11.107	< 0.001^a

^aP < 0.05.

Citation: Ren JY, Wang D, Zhu LH, Liu S, Yu M, Cai H. Combining systemic inflammatory response index and albumin fibrinogen ratio to predict early serious complications and prognosis after resectable gastric cancer. World J Gastrointest Oncol 2024; 16(3): 732-749
URL: https://www.wjgnet.com/1948-5204/full/v16/i3/732.htm
DOI: https://dx.doi.org/10.4251/wjgo.v16.i3.732