| Objective The aim of this study was to investigate the prognostic value of preoperative D-dimer combined with systemic immune-inflammation index(SII)(DD-SII)score in elderly gastric cancer patients after surgery by retrospectively analyzing their preoperative and postoperative clinicopathological data and prognosis,and to provide a basis for clinical diagnosis and treatment strategy selection.Method We retrospectively analyzed the clinicopathological data of patients with gastric cancer treated by surgery in Zhejiang Provincial People’s Hospital from 2010to 2014.The patients’gender,age,tumor site,depth of gastric wall infiltration,tumor stage,degree of differentiation,tissue type,peritoneal metastasis,vascular invasion,liver metastasis,lymph node metastasis,distant metastasis,preoperative CA199 level,preoperative CEA level,preoperative CA125 level,D-dimer level,and preoperative neutrophil,lymphocyte and platelet levels were collected.Meanwhile Patients with gastric cancer were followed up and the postoperative survival time and survival status were collected.SII was defined as neutrophil count*platelet count/lymphocyte count.DD-SII score:a score of 2 for both elevated DD and SII;a score of 1 for only one elevated;and a score of 0 for neither elevated.The ROC curve was used to determine the optimal cut-off value of SII,and the X~2test was used to analyze the relationship between D-dimer,SII and DD-SII scores and clinicopathological characteristics.The Kaplan-Meier method was used to plot survival curves,and the log-rank test was used to compare the overall survival rate between groups;the COX proportional risk regression model was used for univariate and multivariate analysis of risk factors affecting prognostic risk factors.Result A total of 555 elderly gastric cancer patients,132 females and 423 males with a mean age of 69.6 years(60-89 years),were included in this study.The optimal cut-off value of SII was determined as 767 according to the ROC curve,and the elderly gastric cancer patients were divided into 253 cases in the group with SII≤767 and 302 cases in the group with SII>767 based on the optimal cut-off value.323cases in the group with D-dimer≤0.5ug/ml and 232 cases in the group with D-dimer>0.5 ug/ml group in 232 cases.According to the optimal cut-off values of D-dimer and SII,elderly gastric cancer patients were divided into 3 groups:187 cases in the DD-SII score 0 group:D-dimer≤0.5ug/ml and SII≤767;251 cases in the DD-SII score 1 group:D-dimer≤0.5ug/ml and SII>767 or D-dimer>0.5ug/ml and SII≤767.Univariate analysis revealed that D-dimer was associated with age,history of hypertension,history of coronary artery disease,and vascular invasion(P<0.05);SII was associated with age,CA199 level,CEA level,depth of gastric wall infiltration,tumor stage,degree of differentiation,Borrmann staging,peritoneal metastasis,vascular invasion,and liver metastasis.metastasis,vascular invasion,liver metastasis,lymph node metastasis,and distant metastasis(P<0.05);DD-SII score was related to age,history of coronary heart disease,CA199 level,CEA level,depth of gastric wall infiltration,tumor stage,degree of differentiation,Borrmann’s staging,vascular invasion,liver metastasis,lymph node metastasis,and distant metastasis(P<0.05).Multifactorial analysis of comparison between groups with different DD-SII scores revealed that age,degree of differentiation,Borrmann staging and vascular invasion were independent risk factors for DD-SII scores(P<0.05).Kaplan-Meier survival analysis showed that the overall survival rate of elderly gastric cancer patients with D-dimer>0.5ug/ml was significantly lower than that of patients with D-dimer≤0.5ug/ml.The overall survival rate of elderly gastric cancer patients with SII>767 was significantly lower than that of patients with SII≤767(P<0.001).Among the 555elderly gastric cancer patients,the 1-year survival rate,3-year survival rate and overall survival rate were sequentially lower in the groups with DD-SII scores of 0,1and 2.Subgroup analysis showed that among the 251 patients with DD-SII score of 1,of which D-dimer level≤0.5ug/ml and SII>767 were set as group A,136(54.2%).D-dimer level>0.5ug/ml and SII≤767 were set as group B,115(45.8%).1-year survival rate,3-year survival rate and overall survival rate in group A were smaller than those in group B.and overall survival rates in group A were smaller than those in group B.Univariate COX regression analysis showed that preoperative CA199 level,CEA level,depth of gastric wall infiltration,tumor stage,degree of differentiation,Borrmann staging,peritoneal metastasis,vascular invasion,liver metastasis,lymph node metastasis,distant metastasis,SII and DD-SII scores were all correlated with postoperative OS in elderly gastric cancer patients.Multifactorial analysis showed that the depth of gastric wall infiltration,tumor stage,degree of differentiation,Borrmann staging,lymph node metastasis,SII,and DD-SII score were independent risk factors affecting overall survival in elderly patients with gastric cancer.Conclusion The preoperative DD-SII score can be used as a potential marker to predict the prognosis of elderly gastric cancer patients and can assist clinicians in the prognostic assessment of elderly gastric cancer patients. |
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