Abstract Background Tumor immunity plays an important role in assessing the tumor progression. The purpose of this study was to investigate the prognostic value of combined systemic inflammation response index (SIRI) and platelet–lymphocyte ratio (PLR) for treatment of gastroesophageal junction cancer (AEG) and upper gastric cancer (UGC). Methods In this retrospective cohort study, patients from 2003 to 2014 were divided into training set (n=194) and validation set (n=177). The prognostic accuracy of each variable was compared using time-ependent ROC analysis. The scoring system was calculated by cut-off values of SIRI and PLR by ROC curve for survival in 5 years. Kaplan-Meier and Log-rank tests were used to analyze overall survival (OS). The chi-square test was used to analyze the association between clinical characteristics and the scoring system. Univariate and multivariate analyses based on the competitive risk regression model were used to analyze independent predictors of death due to AGC and UGC. The R software was used to construct the Nomogram model of risk assessment. Results Patients with SIRI–PLR=2 had worse survival time than those with 0 and 1 (P<0.001) and more suitable for postoperative adjuvant chemotherapy (P=0.003) and proximal gastrectomy (P=0.045). SIRI and PLR were independent predictors in training set (P=0.036, P=0.045), which could be combined with age and pTNM to construct Nomogram for predicting OS. Conclusions Preoperative SIRI–PLR score was an independent predictor for patients with AEG and UGC. The Nomogram model constructed by age, SIRI, PLR and pTNM can correctly predict the prognosis of patients.

Abstract Background Tumor immunity plays an important role in assessing the tumor progression. The purpose of this study was to investigate the prognostic value of combined systemic inflammation response index (SIRI) and platelet–lymphocyte ratio (PLR) for treatment of gastroesophageal junction cancer (AEG) and upper gastric cancer (UGC). Methods In this retrospective cohort study, patients from 2003 to 2014 were divided into training set (n=194) and validation set (n=177). The prognostic accuracy of each variable was compared using time-ependent ROC analysis. The scoring system was calculated by cut-off values of SIRI and PLR by ROC curve for survival in 5 years. Kaplan-Meier and Log-rank tests were used to analyze overall survival (OS). The chi-square test was used to analyze the association between clinical characteristics and the scoring system. Univariate and multivariate analyses based on the competitive risk regression model were used to analyze independent predictors of death due to AGC and UGC. The R software was used to construct the Nomogram model of risk assessment. Results Patients with SIRI–PLR=2 had worse survival time than those with 0 and 1 (P<0.001) and more suitable for postoperative adjuvant chemotherapy (P=0.003) and proximal gastrectomy (P=0.045). SIRI and PLR were independent predictors in training set (P=0.036, P=0.045), which could be combined with age and pTNM to construct Nomogram for predicting OS. Conclusions Preoperative SIRI–PLR score was an independent predictor for patients with AEG and UGC. The Nomogram model constructed by age, SIRI, PLR and pTNM can correctly predict the prognosis of patients.

Serum CD4, CD8 and CD19 are markers of systemic inflammation. However, there is little evidence on the influence of inflammation on the tumor microenvironment and the prognostic indicators of gastric cancer (GC). In this study, two hundred and eight patients who underwent radical gastrectomy for GC were included. Preoperative peripheral blood samples were used to analyze serum CD4, CD8 and CD19. The optimal cutoff levels for CD4, CD8 and CD19 were defined by receiver operating characteristic curve analysis (CD4=38.85%, CD8=14.35% and CD19=7.40%). The areas with specific CD4+T cells, CD8+T cells and CD19+B cells within the tumor microenvironment were measured in paraffin sections by immunohistochemistry and analyzed by Image-Pro Plus. 94 patients had low CD4 and 124 patients had high CD4 levels. 31 patients had low CD8 and 187 patients had high CD8 levels. 64 patients had low CD19 and 154 patients had high CD19 levels. Infiltration of CD4+T cells was associated with serum CD4 (P<0.001). Serum CD4, CD19, and the infiltration of CD4+T cells, CD8+T cells, and CD19+B cells were significant in predicting the prognosis of GC. Low CD4 level, infiltration of CD8+T cells and high infiltration of CD4+T cells and CD19+B cells were correlated with worse overall survival in multivariate analysis. Collectively, our results provide evidence that serum CD4 is associated with the infiltration of CD4+T cells in the tumor microenvironment, which indicates the prognostic value of systemic inflammation in GC.