Prognostic impact of postoperative systemic inflammatory response in patients with stage II/III gastric cancer
Kenji Kuroda, Takahiro Toyokawa, Yuichiro Miki, Mami Yoshii, Tatsuro Tamura, Hiroaki Tanaka, Shigeru Lee, Kazuya Muguruma, Masakazu Yashiro, Masaichi Ohira
Abstract
Abstract This study examined whether the systemic inflammatory response present in the early phase of the postoperative state correlates with long-term outcomes and to identify markers in patients with stage II/III gastric cancer. 444 consecutive patients who underwent radical gastrectomy for stage II/III gastric cancer were retrospectively reviewed. We evaluated maximum serum C-reactive protein (CRP max ) and white blood cell count (WBC max ), defined as the maximum serum CRP level and maximum WBC count during the interval from surgery until discharge, as systemic inflammation markers. In univariate analyses, CRP max , WBC max and infectious complications were significantly associated with both overall survival (OS) ( p < 0.001, p < 0.001 and p = 0.011, respectively) and relapse-free survival (RFS) ( p < 0.001, p = 0.001 and p < 0.001, respectively). Multivariate analysis revealed that high-CRP max (> 9.2 mg/dL) was an independent prognostic factor for OS (hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.19–2.36, p = 0.003) and RFS (HR 1.56, 95% CI 1.12–2.18, p = 0.009), while WBC max and infectious complications were not. CRP max , which reflects the magnitude of systemic inflammation induced by surgical stress and postoperative complications in the early phase after surgery, may be a promising prognostic indicator in patients with stage II/III gastric cancer who undergo curative resection.