Prognostic value of the preoperative systemic immune-inflammation nutritional index in patients with gastric cancer

Table 1 Baseline patient characteristics based on nutritional risk index, prognostic nutritional index and systemic immuno-inflammatory-nutritional index

Clinicopathological features	N	NRI			PNI			SIINI
		Low (n = 502)	High (n = 301)	P value1	Low (n = 490)	High (n = 313)	P value1	High (n = 243)	Low (n = 560)	P value1
Status				0.001			< 0.001			< 0.001
Censored	548	322	226		311	237		131	417
Death	255	180	75		179	76		112	143
Gender				0.010			> 0.9			0.055
Female	260	146	114		158	102		67	193
Male	543	356	187		332	211		176	367
Age				0.001			< 0.001			0.8
0-51	306	172	134		160	146		88	218
52-62	267	165	102		162	105		83	184
≥ 63	230	165	65		168	62		72	158
Weight ratio				< 0.001			< 0.001			< 0.001
Decrease	246	230	16		169	77		94	152
Stay	381	246	135		236	145		123	258
Increase	176	26	150		85	91		26	150
History of stomach				0.7			0.7			0.5
None/unknown	710	442	268		435	275		218	492
Yes	93	60	33		55	38		25	68
History of surgery				0.089			0.087			0.2
No	797	496	301		484	313		243	554
Yes	6	6	0		6	0		0	6
CEA				< 0.001			< 0.001			0.005
Normal	667	400	267		389	278		188	479
High	136	102	34		101	35		55	81
CA125				0.4			0.002			0.001
Normal	741	460	281		441	300		213	528
High	62	42	20		49	13		30	32
CA19-9				0.021			0.008			0.015
Normal	682	415	267		403	279		195	487
High	121	87	34		87	34		48	73
CA153				0.8			> 0.9			0.5
Normal	778	487	291		475	303		234	544
High	25	15	10		15	10		9	16
AFP				0.067			0.3			0.8
Normal	778	482	296		472	306		235	543
High	25	20	5		18	7		8	17
Pre_tissue				0.2			0.9			0.6
Adenocarcinoma	779	490	289		475	304		237	542
Other/unknown	24	12	12		15	9		6	18
TNM				0.001			< 0.001			< 0.001
Early stage	104	49	55		47	57		27	77
Interim stage	264	164	100		156	108		59	205
Advanced stage	435	289	146		287	148		157	278
Surgery way				0.023			0.005			< 0.001
Radical operation	725	444	281		431	294		201	524
Non-radical surgery	78	58	20		59	19		42	36
Surgery method				0.043			0.012			0.091
Open heart surgery	289	194	95		193	96		98	191
Laparoscopic surgery	514	308	206		297	217		145	369
Complication				0.3			0.3			0.6
No	687	424	263		414	273		210	477
Yes	116	78	38		76	40		33	83
Tumor location				0.3			0.6			0.4
Upper/central	232	152	80		145	87		65	167
Lower section	571	350	221		345	226		178	393
Serous infiltration				0.005			< 0.001			0.004
No/suspected tumour infiltration	239	132	107		124	115		55	184
Tumour infiltration	564	370	194		366	198		188	376
Gastric resection scope				0.022			0.055			0.7
Total gastrectomy	196	136	60		131	65		57	139
Partial gastrectomy	607	366	241		359	248		186	421
Clinical staging				0.001			< 0.001			< 0.001
I	143	69	74		66	77		32	111
II	140	93	47		90	50		34	106
III	416	269	147		260	156		125	291
IV	104	71	33		74	30		52	52
Peritoneal metastasis				0.070			0.054			0.020
No	695	426	269		415	280		200	495
Yes	108	76	32		75	33		43	65
Hb level				< 0.001			< 0.001			> 0.9
Normal	441	235	206		215	226		131	310
Low	346	266	80		274	72		107	239
High	16	1	15		1	15		5	11
PA				< 0.001			< 0.001			< 0.001
Normal	464	239	225		235	229		112	352
Low	333	260	73		254	79		126	207
High	6	3	3		1	5		5	1
ALB				< 0.001			< 0.001			< 0.001
Normal	627	344	283		325	302		154	473
Low	166	158	8		165	1		86	80
High	10	0	10		0	10		3	7
PNI ROC				< 0.001						< 0.001
Low	490	400	90					184	306
High	313	102	211					59	254
SIINI ROC				< 0.001			< 0.001
High	243	186	57		184	59
Low	560	316	244		306	254
NRI ROC							< 0.001			< 0.001
Low					400	102		186	316
High					90	211		57	244

¹Pearson’s χ² test; Fisher’s exact test.

NRI: Nutritional risk index; PNI: Prognostic nutritional index; SIINI: Systemic immune-inflammatory-nutritional index; CEA: Carcinoembryonic antigen; CA125: Carbohydrate antigen 125; AFP: Alpha-fetoprotein; TNM: Tumor, node, metastasis; Hb: Haemoglobin; PA: Prealbumin; ALB: Albumin; ROC: Receiver operating characteristic.

Table 2 Univariate and multivariate Cox regression analysis of the associations between clinical parameters and overall survival in patients with gastric cancer, n (%)

Variable		n	HR (univariate analysis)	HR (multivariate analysis)
SIINI	mean ± SD	114.5 ± 184.3	1.00 (1.00-1.00, P = 0.356)
Gender	Female	260 (32.4)
	Male	543 (67.6)	1.00 (0.77-1.30, P = 0.993)
Age	0-51	306 (38.1)
	52-62	267 (33.3)	1.19 (0.88-1.60, P = 0.267)	1.04 (0.75-1.43, P = 0.833)
	≥ 63	230 (28.6)	1.31 (0.97-1.77, P = 0.074)	1.27 (0.92-1.76, P = 0.145)
Weight ratio	Decrease	246 (30.6)
	Stay	381 (47.4)	1.08 (0.82-1.42, P = 0.595)	0.93 (0.68-1.27, P = 0.655)
	Increase	176 (21.9)	0.69 (0.48-1.01, P = 0.054)	0.81 (0.49-1.36, P = 0.431)
History of stomach	None/unknown	710 (88.4)
	Yes	93 (11.6)	1.32 (0.92-1.89, P = 0.133)	1.03 (0.70-1.53, P = 0.874)
History of surgery	No	797 (99.3)
	Yes	6 (0.7)	3.97 (1.27-12.42, P = 0.018)	3.49 (1.02-11.90, P = 0.046)
CEA	Normal	667 (83.1)
	High	136 (16.9)	1.36 (1.00-1.85, P = 0.051)	0.76 (0.54-1.06, P = 0.104)
CA125	Normal	741 (92.3)
	High	62 (7.7)	2.94 (2.01-4.28, P < 0.001)	1.74 (1.14-2.65, P = 0.010)
CA19-9	Normal	682 (84.9)
	High	121 (15.1)	2.28 (1.70-3.04, P < 0.001)	1.60 (1.18-2.16, P = 0.003)
CA153	Normal	778 (96.9)
	High	25 (3.1)	1.15 (0.57-2.32, P = 0.701)
AFP	Normal	778 (96.9)
	High	25 (3.1)	0.88 (0.42-1.87, P = 0.746)
Pre-tissue	Adenocarcinoma	779 (97.0)
	Other/unknown	24 (3.0)	1.37 (0.68-2.76, P = 0.384)
TNM	Early stage	104 (13.0)
	Interim stage	264 (32.9)	1.89 (1.15-3.12, P = 0.013)	0.98 (0.58-1.67, P = 0.949)
	Advanced stage	435 (54.2)	2.48 (1.54-4.00, P < 0.001)	1.03 (0.61-1.72, P = 0.925)
Surgery way	Radical operation	725 (90.3)
	Non-radical surgery	78 (9.7)	3.31 (2.32-4.72, P < 0.001)	1.56 (0.86-2.84, P = 0.143)
Surgery method	Open heart surgery	289 (36.0)
	Laparoscopic surgery	514 (64.0)	1.05 (0.81-1.37, P = 0.702)
Complication	No	687 (85.6)
	Yes	116 (14.4)	1.49 (1.08-2.06, P = 0.015)	1.61 (1.14-2.26, P = 0.006)
Tumor location	Upper/central	232 (28.9)
	Lower section	571 (71.1)	0.79 (0.61-1.02, P = 0.073)	1.14 (0.82-1.59, P = 0.446)
Serous infiltration	No/suspected tumour infiltration	239 (29.8)
	Tumour infiltration	564 (70.2)	2.84 (2.03-3.97, P < 0.001)	1.35 (0.94-1.95, P = 0.105)
Gastric resection scope	Total gastrectomy	196 (24.4)
	Partial gastrectomy	607 (75.6)	0.61 (0.46-0.79, P < 0.001)	0.71 (0.50-1.01, P = 0.058)
Clinical staging	I	143 (17.8)
	II	140 (17.4)	5.95 (2.49-14.24, P < 0.001)	3.69 (1.50-9.06, P = 0.004)
	III	416 (51.8)	12.28 (5.44-27.75, P < 0.001)	6.29 (2.67-14.86, P < 0.001)
	IV	104 (13.0)	29.69 (12.73-69.25, P < 0.001)	10.24 (3.83-27.38, P < 0.001)
Peritoneal metastasis	No	695 (86.6)
	Yes	108 (13.4)	8.06 (6.20-10.48, P < 0.001)	6.06 (4.60-7.98, P < 0.001)
Hb level	Normal	441 (54.9)
	Low	346 (43.1)	1.13 (0.89-1.45, P = 0.317)
	High	16 (2.0)	0.52 (0.16-1.62, P = 0.256)
PA	Normal	464 (57.8)
	Low	333 (41.5)
	High	6 (0.7)
ALB	Normal	627 (78.1)
	Low	166 (20.7)	1.26 (0.95-1.68, P = 0.108)	0.94 (0.67-1.31, P = 0.704)
	High	10 (1.2)	1.70 (0.63-4.57, P = 0.296)	1.45 (0.49-4.31, P = 0.505)
NRI ROC	Low	502 (62.5)
	High	301 (37.5)	0.68 (0.52-0.89, P = 0.005)	1.29 (0.85-1.94, P = 0.229)
PNI ROC	Low	490 (61.0)
	High	313 (39.0)	0.60 (0.46-0.79, P < 0.001)	0.76 (0.54-1.06, P = 0.103)
SIINI ROC	Low	560 (69.7)
	High	243 (30.3)	2.10 (1.64-2.69, P < 0.001)	1.65 (1.26-2.16, P < 0.001)

n = 803, events = 255, Likelihood ratio test = 355.39 on 25 df (P < 0.001). HR: Hazard ratio; NRI: Nutritional risk index; PNI: Prognostic nutritional index; SIINI: Systemic immune-inflammatory-nutritional index; CEA: Carcinoembryonic antigen; CA125: Carbohydrate antigen 125; AFP: Alpha-fetoprotein; TNM: Tumor, node, metastasis; Hb: Haemoglobin; PA: Prealbumin; ALB: Albumin; ROC: Receiver operating characteristic.