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©The Author(s) 2024.
World J Gastrointest Oncol. Mar 15, 2024; 16(3): 732-749
Published online Mar 15, 2024. doi: 10.4251/wjgo.v16.i3.732
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 | |
Sex | ||||
Male | 378 (78.9) | 64 (71.9) | 0.1441 | |
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 |
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 |
≥ 3 | 331 (69.1) | 73 (82.0) | ||
Differentiation | Moderate and poor | 460 (96.0) | 86 (96.6) | 11 |
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 |
Total gastrectomy | 231 (48.2) | 55 (61.8) | ||
ASA | I-II | 433 (90.4) | 76 (85.4) | 0.1551 |
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 |
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) |
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) | 0.002a | 11.96 ± 3.68 | 0.252 |
Female | 0.91 (0.87) | 11.62 ± 2.77 | |||
Age in yr | < 60 | 1.03 (0.86) | 0.038a | 12.58 ± 3.83 | < 0.001a |
≥ 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) | < 0.001a | 13.44 ± 3.86 | < 0.001a |
≥ 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) | < 0.001a | 13.70 ± 4.20 | < 0.001a |
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) | 0.008a | 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) | < 0.001a | 12.37 ± 3.50 | < 0.001a |
Yes | 1.44 (1.20) | 10.25 ± 3.00 | |||
CA199 in ng/mL | Negative | 1.06 (0.86) | 0.023a | 12.14 ± 3.16 | 0.001a |
Positive | 1.23 (1.17) | 10.57 ± 2.83 | |||
CEA in ng/mL | Negative | 1.03 (0.83) | < 0.001a | 12.24 ± 3.59 | < 0.001a |
Positive | 1.29 (1.30) | 10.58 ± 2.81 | |||
Blood loss in mL | < 200 | 1.02 (0.77) | 0.011a | 12.24 ± 3.63 | 0.013a |
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) | < 0.001a | 12.65 ± 3.35 | < 0.001a |
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 | 0.01a |
> 7 d | 1.15 (0.88) | 11.40 ± 3.23 |
Table 4 Univariate and multivariate analyses of the logistic regression model for postoperative complications in patients with gastric cancer
Variables | Univariate analysis | Multivariate analysis | ||||
OR | 95%CI | P value | OR | 95%CI | P value | |
Age in yr | 1.025 | 1.000-1.049 | 0.046a | 1.011 | 0.984-1.040 | 0.427 |
BMI | 0.896 | 0.832-0.964 | 0.003a | 0.939 | 0.864-1.020 | 0.135 |
Tumor dimensions in cm | 2.04 | 1.148-3.624 | 0.015a | 0.869 | 0.443-1.706 | 0.684 |
Operation | 1.737 | 1.092-2.761 | 0.02a | 1.619 | 0.944-2.777 | 0.080 |
Perioperative transfusion | 3.371 | 2.091-5.434 | < 0.001a | 2.095 | 1.179-3.722 | 0.012 |
CEA in ng/mL | 1.905 | 1.154-3.146 | 0.012a | 1.268 | 0.711-2.262 | 0.421 |
Neutrophil count | 1.413 | 1.240-1.609 | < 0.001a | 2.036 | 1.240-1.609 | < 0.001a |
Monocyte count | 4.092 | 1.005-16.663 | 0.049a | 10.259 | 0.672-16.609 | 0.086 |
Lymphocyte count | 0.381 | 0.232-0.626 | < 0.001a | 0.161 | 0.053-0.493 | 0.001a |
Albumin | 0.876 | 0.833-0.921 | < 0.001a | 0.956 | 0.898-1.017 | 0.152 |
Fibrinogen | 2.328 | 0.833-0.921 | < 0.001a | 1.808 | 1.341-2.439 | < 0.001a |
SIRI | 1.429 | 1.790-3.027 | < 0.001a | 1.221 | 1.031-1.446 | 0.018a |
AFR | 0.729 | 0.665-0.799 | < 0.001a | 0.761 | 0.693-0.843 | < 0.001a |
Table 5 Univariate and multivariate Cox regression analysis for overall survival in gastric cancer patients
Variables | Univariate analysis | Multivariate analysis | |||||
HR | 95%CI | P value | HR | 95%CI | P value | ||
Age in yr | 1.024 | 1.005-1.043 | 0.013a | 1.000 | 0.981-1.020 | 0.964 | |
Tumor dimensions in cm | |||||||
< 3/≥ 3 | 3.143 | 1.932-5.112 | < 0.001a | 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 | < 0.001a | < 0.001a | |||||
I | Ref | Ref | |||||
II | 3.550 | 1.570-8.027 | 0.002a | 1.777 | 0.665-4.748 | 0.479 | |
III | 7.097 | 3.290-15.306 | < 0.001a | 5.464 | 1.948-15.327 | 0.001a | |
Operation time in min | 1.003 | 1.001-1.006 | 0.003a | 1.003 | 1.000-1.005 | 0.055 | |
Perioperative transfusion | No/yes | 2.564 | 1.811-3.629 | < 0.001a | 1.517 | 1.011-2.277 | 0.044a |
CA199 in ng/mL | Negative/positive | 1.990 | 1.347-2.940 | 0.001a | 1.184 | 0.776-1.807 | 0.433 |
CEA in ng/mL | Negative/positive | 2.126 | 1.490-3.034 | < 0.001a | 1.605 | 1.101-2.338 | 0.014a |
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 | < 0.001a | 1.450 | 0.956-2.200 | 0.080 |
Postoperative chemotherapy | No/yes | 1.916 | 1.239-2.963 | 0.003a | 0.628 | 0.357-1.104 | 0.106 |
Lymphocytes as × 109/L | 0.490 | 0.347-0.692 | < 0.001a | 0.840 | 0.553-1.1275 | 0.413 | |
Neutrophils as × 109/L | 1.240 | 1.152-1.335 | < 0.001a | 1.075 | 0.357-1.104 | 0.106 | |
Monocyte as × 109/L | 7.393 | 2.685-20.351 | < 0.001a | 0.762 | 0.188-3.086 | 0.703 | |
Albumin in g/L | 0.880 | 0.850-0.911 | < 0.001a | 0.969 | 0.927-1.013 | 0.164 | |
Fibrinogen in g/L | 2.063 | 1.792-2.375 | < 0.001a | 1.415 | 1.111-1.803 | 0.005a | |
SIRI | 1.190 | 1.117-1.267 | < 0.001a | 1.036 | 0.764-1.404 | 0.820 | |
AFR | 0.727 | 0.681-0.776 | < 0.001a | 1.059 | 0.858-1.308 | 0.592 | |
SIRI-AFR score | < 0.001a | ||||||
0 | Ref | Ref | |||||
1 | 6.034 | 2.964-12.285 | < 0.001a | 3.134 | 1.445-6.797 | 0.004a | |
2 | 20.555 | 10.287-41.071 | < 0.001a | 5.239 | 2.122-12.935 | < 0.001a |
Table 6 Univariate and multivariate Cox regression analysis for disease-free survival in gastric cancer patients
Variables | Univariate analysis | Multivariate analysis | |||||
HR | 95%CI | P value | HR | 95%CI | P value | ||
Age in yr | 1.026 | 1.009-1.043 | 0.003a | 1.005 | 0.988-1.022 | 0.589 | |
Tumor dimensions in cm | < 3/≥ 3 | 2.679 | 1.772-4.051 | < 0.001a | 1.165 | 0.736-1.844 | 0.514 |
Differentiation | Moderate and poor/well | 0.241 | 0.060-0.974 | 0.046a | 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 | < 0.001a | < 0.001a | |||||
I | Ref | Ref | |||||
II | 2.920 | 1.546-5.512 | 0.001a | 1.726 | 0.774-3.850 | 0.182 | |
III | 5.167 | 2.844-9.387 | < 0.001a | 4.071 | 1.757-9.435 | 0.001a | |
Operation time in min | 1.003 | 1.001-1.005 | 0.014a | 1.002 | 0.999-1.004 | 0.201 | |
Perioperative transfusion | No/yes | 2.288 | 1.666-3.141 | < 0.001a | 1.377 | 0.954-1.989 | 0.088 |
CA199 in ng/mL | Negative/positive | 1.852 | 1.292-2.653 | 0.001a | 1.251 | 0.851-1.838 | 0.255 |
CEA in ng/mL | Negative/positive | 1.780 | 1.280-2.476 | 0.001a | 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 | < 0.001a | 1.604 | 1.115-2.307 | 0.011a |
Postoperative chemotherapy | No/yes | 1.836 | 1.248-2.702 | 0.002a | 0.609 | 0.365-1.018 | 0.059 |
Lymphocytes as × 109/L | 0.515 | 0.378-0.703 | < 0.001a | 0.954 | 0.669-1.359 | 0.792 | |
Neutrophils as × 109/L | 1.192 | 1.119-1.269 | < 0.001a | 1.036 | 0.938-1.144 | 0.484 | |
Monocyte as × 109/L | 5.946 | 2.457-14.387 | < 0.001a | 0.980 | 0.301-3.188 | 0.973 | |
Albumin in g/L | 0.884 | 0.857-0.912 | < 0.001a | 0.959 | 0.920-0.999 | 0.044a | |
Fibrinogen in g/L | 2.141 | 1.867-2.456 | < 0.001a | 1.407 | 1.126-1.759 | 0.003a | |
SIRI | 1.142 | 1.080-1.207 | < 0.001a | 1.076 | 0.913-1.268 | 0.380 | |
AFR | 0.735 | 0.692-0.780 | < 0.001a | 0.931 | 0.700-1.239 | 0.625 | |
SIRI-AFR score | < 0.001a | ||||||
0 | Ref | Ref | |||||
1 | 6.042 | 3.339-10.931 | < 0.001a | 3.543 | 1.844-6.809 | < 0.001a | |
2 | 18.207 | 10.138-32.699 | < 0.001a | 5.005 | 2.256-11.107 | < 0.001a |
- 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