Ren Jing-Yao, Wang Da, Zhu Li-Hui, Liu Shuo, Yu Miao, Cai Hui
School of Clinical Medicine, Ningxia Medical University, Yinchuan 750000, Ningxia Hui Autonomous Region, China.
General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China.
World J Gastrointest Oncol. 2024 Mar 15;16(3):732-749. doi: 10.4251/wjgo.v16.i3.732.
Gastric cancer has a high incidence and fatality rate, and surgery is the preferred course of treatment. Nonetheless, patient survival rates are still low, and the incidence of major postoperative complications cannot be disregarded. The systemic inflammatory response, nutritional level, and coagulation status are key factors affecting the postoperative recovery and prognosis of gastric cancer patients. The systemic inflammatory response index (SIRI) and the albumin fibrinogen ratio (AFR) are two valuable comprehensive indicators of the severity and prognosis of systemic inflammation in various medical conditions.
To assess the clinical importance and prognostic significance of the SIRI scores and the AFR on early postoperative outcomes in patients undergoing radical gastric cancer surgery.
We conducted a retrospective analysis of the clinicopathological characteristics and relevant laboratory indices of 568 gastric cancer patients from January 2018 to December 2019. We calculated and compared two indicators of inflammation and then examined the diagnostic ability of combined SIRI and AFR values for serious early postoperative complications. We scored the patients and categorized them into three groups based on their SIRI and AFR levels. COX analysis was used to compare the three groups of patients the prognostic value of various preoperative SIRI-AFR scores for 5-year overall survival (OS) and disease-free survival (DFS).
SIRI-AFR scores were an independent risk factor for prognosis [OS: = 0.004; hazards ratio (HR) = 3.134; DFS: < 0.001; HR = 3.543] and had the highest diagnostic power (area under the curve: 0.779; 95% confidence interval: 0.737-0.820) for early serious complications in patients with gastric cancer. The tumor-node-metastasis stage ( = 0.001), perioperative transfusion ( = 0.044), positive carcinoembryonic antigen ( = 0.014) findings, and major postoperative complications ( = 0.011) were factors associated with prognosis.
Preoperative SIRI and AFR values were significantly associated with early postoperative survival and the occurrence of severe complications in gastric cancer patients.
胃癌发病率和死亡率高，手术是首选治疗方法。尽管如此，患者生存率仍低，术后主要并发症的发生率也不容忽视。全身炎症反应、营养水平和凝血状态是影响胃癌患者术后恢复和预后的关键因素。全身炎症反应指数（SIRI）和白蛋白纤维蛋白原比值（AFR）是各种医疗状况下全身炎症严重程度和预后的两个有价值的综合指标。
评估SIRI评分和AFR对接受根治性胃癌手术患者术后早期结局的临床重要性和预后意义。
我们对2018年1月至2019年12月期间568例胃癌患者的临床病理特征和相关实验室指标进行了回顾性分析。我们计算并比较了两个炎症指标，然后检验了联合SIRI和AFR值对术后早期严重并发症的诊断能力。我们对患者进行评分，并根据他们的SIRI和AFR水平将其分为三组。采用COX分析比较三组患者各种术前SIRI-AFR评分对5年总生存（OS）和无病生存（DFS）的预后价值。
SIRI-AFR评分是预后的独立危险因素[OS：=0.004；风险比（HR）=3.134；DFS：<0.001；HR=3.543]，对胃癌患者早期严重并发症具有最高的诊断效能（曲线下面积：0.779；95%置信区间：0.737-0.820）。肿瘤-淋巴结-转移分期（=0.001）、围手术期输血（=0.044）、癌胚抗原阳性（=0.014）结果和术后主要并发症（=0.011）是与预后相关的因素。
术前SIRI和AFR值与胃癌患者术后早期生存及严重并发症的发生显著相关。
