br Conclusion The ACCI of patients with gastric cancer was
Conclusion: The ACCI of patients with gastric cancer was associated with preoperative systemic inflammation. The ACCI combined with the NLR, which are commonly collected biomarkers, could enhance prognostication for GC patients.
* Corresponding author. Department of Gastric Surgery, Fujian Medical Univer-sity Union Hospital, Fuzhou, Fujian Province, China.; ** Corresponding author. Department of Gastric Surgery, Fujian Medical Univer-sity Union Hospital, Fuzhou, Fujian Province, China. *** Corresponding author. Department of Gastric Surgery, Fujian Medical Uni-versity Union Hospital, Fuzhou, Fujian Province, China. E-mail addresses: [email protected] (C.-H. Zheng), [email protected] (C.-M. Huang), [email protected] (P. Li).
1 Lin JX and Huang YQ contributed equally to this work and should be considered co-first authors.
Although the incidence and mortality of GC have declined worldwide , GC is still the fifth most common malignant tumor in the world and the third most common cause of death related to cancer worldwide (723,000 deaths, accounting for 8.8% of the total) . In addition, with the aging of the population and the increase in life expectancy, the proportion of elderly patients with GC is constantly increasing. Previous study have shown that people over 70 years old account for 30% of patients with GC . However, as the functional reserve of the human body tends to decline with age,
Please cite this article as: Lin J-X et al., Association of the age-adjusted Charlson Comorbidity Index and systemic 66-81-9 with survival in gastric cancer patients after radical gastrectomy, European Journal of Surgical Oncology, https://doi.org/10.1016/j.ejso.2019.07.010
2 J.-X. Lin et al. / European Journal of Surgical Oncology xxx (xxxx) xxx
elderly patients often have more comorbidities , leading to the poor prognosis of patients [5e9]. Therefore, this part of the popu-lation is increasingly attracting attention. In 1994, Charlson et al. established a new scoring system, the Age-Adjusted Charlson Co-morbidity Index (ACCI) , which made the preoperative evalu-ation of patients more convenient.
In 1863, Virchow first found a link between malignancy and inflammation . Systemic inflammation is considered to play a key role in the pathogenesis and development of tumors . The disease progression of malignancy and tumor-specific survival are determined not only by the intrinsic characteristics of the tumor but also by the characteristics of the host, especially the systemic inflammation. Studies have shown that markers of systemic inflammation, including the lymphocyte to monocyte ratio (LMR), NLR and platelet to lymphocyte ratio (PLR), are closely related to the prognosis of various tumors [13e16]. The increase in markers of systemic inflammation often indicates the existence of preop-erative comorbidities . Clinically, most patients with preop-erative comorbidities are elderly patients. The aging process is often accompanied by immune and endocrine-metabolic disor-ders in turn . However, the correlation between the ACCI and systemic inflammation in patients with GC and their coeffect on prognosis have not been reported. Therefore, the purpose of this study was to evaluate the association of the ACCI and systemic inflammation with survival in GC patients who underwent radical surgery.
Patients and methods
Data from primary GC patients who underwent radical gas-trectomy in the Affiliated Union Hospital of Fujian Medical Uni-versity from January 2009 to December 2014 were obtained from a prospectively maintained gastric cancer database and retrospec-tively analyzed. The inclusion criteria were as follows: (1) histo-logically confirmed primary gastric adenocarcinoma; (2) no distant metastasis; and (3) radical gastrectomy with R0 resection and regional lymphadenectomy. Patients who met the following criteria were excluded from this study: (1) patients with primary GC invading the surrounding organs or metastasis, (2) patients with gastric stump carcinoma, and (3) patients with incomplete/inac-curate medical records. In total, 2257 patients were enrolled. The extent of gastrectomy and the dissection of the lymph nodes around the stomach were in accordance with the fourth edition of the Japanese gastric cancer treatment guidelines . Staging was performed according to the corresponding part of the eighth edi-tion of the AJCC Staging Manual . r> Definition of the ACCI
The ACCI, as defined by Charlson et al., is a combination of the age equivalence index and Charlson Comorbidity Index. Each decade of age over 40 adds 1 point to risk (e.g., 50e59 years, 1 point; 60e69 years, 2 points; and 70e79 years, 3 points), and the points for age are added to the score from the Charlson comorbidity index (e.g., 0, 1, 2, and 3). Conditions that had completely resolved (i.e., history of pneumonia) or a history of operation for currently inactive conditions (i.e., history of cholecystectomy) were not counted as comorbid diseases . The optimal cutoff value of the ACCI was obtained by X-tile (Version 3.6.1, Yale University). Thus, the patients were divided into three groups: a low ACCI group (ACCI ¼ 0e1), a middle ACCI group (ACCI ¼ 2), and a high ACCI group (ACCI ¼ 3e10).