Aim: We examined whether the perioperative systemic inflammation score (SIS), which describes systemic inflammation and/or malnutrition, affected the tumor recurrence and survival in advanced gastric cancer patients. Patients and Methods: The study retrospectively analyzed 160 patients with stage II/III gastric cancer who underwent curative resection at the Kanagawa Cancer Center. The SIS was evaluated before surgery, one week after surgery and one month after surgery, as determined by the serum albumin level (cut-off value=4.0 g/dl) and lymphocyte-to-monocyte ratio (cut-off value=4.44). Results: A high SIS at one month after surgery was identified as an independent predictor for overall survival [hazard ratio (HR)=2.143, p=0.020] and showed a marginal significance for the relapse-free survival (HR=1.814, p=0.053) in multivariate analyses. Conclusion:The SIS at one month after surgery is a useful biomarker for predicting the long-term outcome in patients with advanced gastric cancer.Gastric cancer is third-most frequent cause of cancer-related death worldwide (1), and prognosis is still unfavorable, especially in advanced gastric cancer, although the surgical procedures and perioperative treatment approaches have been improved over time (2)(3)(4)(5)(6).Previous studies showed that systemic inflammation and/or malnutrition can affect long-term survival in patients with malignancies (7-9). Recently, the systemic inflammation score (SIS) was reported as a strong prognostic factor for renal cell carcinoma and colorectal cancer (10,11). The preoperative SIS was also reported to be associated with the long-term outcome in patients with gastric cancer (12).However, patients with gastric cancer are likely to develop postoperative systemic inflammation and/or malnutrition due to surgical stress, postoperative complications and difficulty achieving oral intake, which can affect tumor recurrence or compliance with adjuvant chemotherapy (13-16). Therefore, the postoperative SIS may affect the long-term survival in patients with gastric cancer, although this has not been reported. If the SIS after gastrectomy is indeed a prognosticator for patients with gastric cancer, we can improve the long-term outcomes of advanced gastric cancer patients through low-invasive surgery or nutritional intervention.In the present study, we retrospectively evaluated the perioperative SIS and examined whether it affected the tumor recurrence and survival in patients who underwent curative resection for advanced gastric cancer. Patients and MethodsThe patients were retrospectively selected from the medical database of gastric cancer patients who underwent gastrectomy at the Department of Gastrointestinal Surgery of Kanagawa Cancer Center, according to the following criteria: 1) histologically proven common-type adenocarcinoma, according to the 15 th edition of the Japanese Classification of Gastric Carcinoma (JCGC) published by the Japanese Gastric Cancer Association (JGCA) (17); 2) curative resection (R0 resection) with sufficient nodal dissec...

Background Surgery for gastric cancer should be performed as soon as possible after diagnosis. However, sometimes the waiting time for surgery tends to be longer. The relation between the waiting time for surgery and survival in patients with gastric cancer remains to be fully investigated. Methods This retrospective, single-center cohort study evaluated patients with gastric cancer who underwent curative surgery from 2006 through 2012 at Kanagawa Cancer Center in Japan. Patients who received neoadjuvant chemotherapy were excluded. The waiting time for surgery was defined as the time between the first visit and surgery. We investigated whether the waiting time for surgery has a linear negative impact on outcomes by using a Cox regression model with clinical prognostic factors. Results In total, 801 patients were eligible. The median waiting time was 45 days (range 10-269 days). The restricted cubic spline regression curve showed that the adjusted time-specific hazard ratios of waiting times did not indicate a linear negative trend on survival between 20 and 100 days (p = 0.759). In the Cox model with a quartile of waiting times, waiting times in the 32-44-day group, 43-62-day group, and C63 day groups were not associated with poorer overall survival as compared with the B31 day group (HR: 1.01, 95% CI 0.63-1.60, p = 0.984, HR: 1.17, 95% CI 0.70-1.94, p = 0.550, HR: 1.06, 95% CI 0.60-1.88, p = 0.831, respectively). Conclusions There was no negative relation between the waiting time for surgery (within 100 days) and survival in patients with gastric cancer.

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Background: We investigated the impact of the pre-surgical C-reactive protein-to-albumin ratio (CAR) on survival and recurrence after curative treatment for gastric cancer. Patients and Methods: This study included 481 patients who underwent curative treatment for gastric cancer between 2013 and 2017. The risk factors for overall (OS) and recurrence-free (RFS) survival were identified. Results: A CAR of 0.05 was regarded as the optimal critical point of classification considering the 3-and 5-year survival rates and patients were divided according to their CAR. The OS rates at 3 and 5 years after surgery were significantly higher at 92.5% and 87.9%, respectively, in the low-CAR group compared with 84.9% and 71.9%, respectively, in the high-CAR group. The corresponding RFS rates were 89.1% and 85.5%, and 81.0% and 72.2%, respectively, also a significant difference. A multivariate analysis demonstrated that the CAR was a significant independent risk factor for the OS and marginally significant independent risk factor for the RFS. In addition, the incidences of pancreatic fistula and abdominal abscess were significantly higher and the rate of introduction of adjuvant chemotherapy significantly lower in the high-CAR group. Conclusion: The CAR was a risk factor influencing survival in patients who underwent curative treatment for gastric cancer. An effective perioperative care plan and surgical strategy need to be developed according to the CAR.