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

Abstract Background 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. Methods 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) and C-reactive protein (CRP) level (pre-CRP) and postoperative maximum WBC count (WBCmax) and maximum serum CRP level (CRPmax) were evaluated as prognostic inflammation markers. Results Among prognostic inflammation markers, multivariate analysis revealed pre-CRP and WBCmax as independent prognostic factors (Hazard ratio (HR) 1.645, 95% confidence interval (CI) 1.015–2.652, p = 0.043 and HR 1.913; 95%CI 1.142–3.221, p = 0.014, respectively). Perioperative inflammation score (PIS) constructed with pre-CRP and WBCmax allowed clear classification of patients into three groups for survival, and was revealed as an independent prognostic factor (PIS 1: HR 1.512, 95%CI 0.891–2.607 and PIS 2: HR 3.868, 95%CI 2.032–7.267, p < 0.001). Conclusions High pre-CRP and high WBCmax were independent prognostic factors for OS in elderly patients with gastric cancer after R0 resection. Furthermore, PIS is a promising prognostic indicator and may help surgeons offer optimized treatment strategies for elderly patients with gastric cancer.