The Prognostic Impact of Perioperative Inflammatory Status in Elderly Patients With Gastric Cancer

This study aimed to elucidate pre- and postoperative inflammatory prognostic factors, and to evaluate the impact of a combined perioperative inflammation marker for survival in elderly patients with gastric cancer.

We retrospectively examined 193 consecutive elderly patients ≥75 years of age who underwent curative gastrectomy for gastric cancer. Preoperative white blood cell (WBC) count (pre-WBC), C-reactive protein (CRP) level (pre-CRP), postoperative maximum WBC count (WBC_max), and maximum serum CRP level (CRP_max) were evaluated as prognostic inflammation markers.

Among prognostic inflammation markers, multivariate analysis revealed WBC_max as an independent prognostic factor [hazard ratio (HR)=1.746, 95% confidence interval (CI)=1.026-2.970; p=0.040]. Perioperative inflammation score (PIS) constructed with pre-CRP and WBC_max allowed clear classification of patients into three groups for survival, and was revealed as an independent prognostic factor (PIS 1, either high pre-CRP or high WBC_max: HR=1.378, 95% CI=0.807-2.352 and PIS 2, both high pre-CRP and high WBC_max: HR=3.168, 95% CI=1.631-6.156, p=0.002).

High WBC_max was an independent prognostic factor for overall survival in elderly patients with gastric cancer after R0 resection. Furthermore, PIS is a promising prognostic indicator, suggesting that controlling perioperative inflammatory status could improve the prognosis in elderly patients with gastric cancer.