| Background: Inflammation and immune status play a key role in the development of tumors;cytokines and chemokines,indeed secreted by inflammatory cells promote tumor growth.Surgery treatment of gastric cancer is still a recognized effective method.There is indicated that the primary tumor surgical resection promote the development of tumor metastasis;however,the perioperative therapy of tumor patients has a great impact on the prognosis.In order to study the impact of perioperative inflammatory immune status on the prognosis of gastric cancer patients and its potential value in the long-term prognosis prediction of TNM I-III gastric cancer patients,a new prognostic scoring system-perioperative inflammatory immune score prognosis(PPS).Methods: The clinical and pathological data of 420 patients with gastric cancer who underwent radical resection of distal gastric cancer from February 2014 to April 2019 were retrospectively analyzed.X-Tile software was used to analyze the cutoff points and relative risk ratios of NLR,PLR,PNI,and AGR for 420 patients with gastric cancer before surgery,1 day after surgery,and 7 days after surgery.“0”and “1” points were assigned according to the cutoff points.The TNM stage I-II is assigned “1” point,and the stage III is “5” points.The perioperative inflammatory immune score prognosis system(PPS)is calculated,and then the X-Tile software is used to obtain a PPS grade based on the 5-year overall survival time.1-6 is classified as "Low-risk",7-10 is classified as "Medium-risk",11-17 is classified as "High-risk".Kaplan-Meier method is used to calculate survival time,and Cox proportional hazard regression model estimates hazard ratios(HRs)and 95%confidence intervals(CI).The time-dependent ROC curve was used to compare the PPS and TNM stage predict prognosis capabilities,obtained AUC area.The external validation group was used to verify the prediction prognosis model obtained by the test group.Results: The perioperative inflammatory immune score prognosis system(PPS)classification is "low-risk(1-6 points)","medium-risk(7-10 points)","high-risk(11-17 points)".There 5-year overall survival rate were 91.46%,69.44%,and46.97%,respectively in the test group.246 cases of PPS were "low-risk"(5-year mortality 8.54%),108 cases of " medium-risk"(5-year mortality 30.56%)[HR:3.831;95% CI: 2.175-6.747;P <0.0001],66 cases of "high-risk"(5-year mortality53.03%)[HR: 6.833;95% CI: 3.715-12.568;P <0.0001]."High-risk" mortality rate is highest than others,the difference is statistically significant.Multivariate analysis shows that PPS is an independent predictor of OS(P = 0.000);using a time-dependent ROC curve to analyze the 5-year overall survival time of PPS and TNM stage,the AUC areas were 0.794 and 0.741,respectively;P < 0.0001,the difference is statistically significant.The 5-year overall survival rates of "low-risk","medium-risk",and "high-risk" were respectively 89.42%,62.96%,and 28.57% in the external validation group.104 cases of "low-risk" of PPS(5-year mortality10.58%),27 cases of "medium-risk"(5-year mortality37.04%)[HR: 2.560;95%CI: 1.156-6.642;P = 0.002],14 cases of "high risk"(5-year mortality 71.43%)[HR: 5.648 95% CI: 2.161-14.763;P = 0.002];the same results were obtained in the external validation group.The "low-risk" 5-year overall survival time was highest than others,the difference is statistically significant.The time-dependent ROC curve is used to verify the 5-year overall survival time and the AUC area of? ? PPS compared with TNM stage.The AUC area were 0.810 and 0.713,respectively;P <0.0001,the difference was statistically significant.Conclusion: The perioperative inflammatory immune score prognosis system(PPS)based on perioperative NLR,PLR,PNI and AGR combined with TNM stage with radical gastric cancer resection is an independent predictor of overall survival(OS),which is expected to be a valuable predictor of the prognosis of gastric cancer patients. |
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