Abstract:

Objective To analyze the relationship between inflammatory burden index （IBI） and the diagnosis and prognosis of gastric cancer. Methods A total of 180 patients with gastric cancer admitted to the First Affiliated Hospital of Xi'an Medical University from January 1， 2017 to December 31， 2021 were selected as the gastric cancer group， 180 cases of gastric precancerous diseases treated in this hospital during the same period were selected as the precancerous disease group， 180 healthy individuals who underwent physical examinations in this hospital during the same period were selected as the control group. The value of IBI in the diagnosis of gastric cancer was analyzed. The IBI values of the three groups were compared by one-way analysis of variance， and the optimal cut-off values of different indicators were determined by receiver operator characteristic （ROC） curve to further evaluate the diagnostic value of IBI for gastric cancer. LASSO regression analysis was performed using the R software package glmnet to screen variables. Univariate and multivariate Cox regression analysis were performed on the screened variables to further determine the independent risk factors affecting the prognosis of patients with gastric cancer. Results The levels of IBI in gastric cancer， precancerous disease， and control group were 46.69±8.38， 35.53±6.11， and 21.47±4.36， respectively， with a statistically significant difference （F=681.45， P<0.001）. Further pairwise comparisons showed that the gastric cancer group was higher than the precancerous disease group and the control group, and the precancerous disease group was higher than the control group， with statistically significant differences（t=14.43， P<0.001; t=34.15， P<0.001; t=25.13， P<0.001）. ROC curve analysis showed that the optimal cut-off value for the neutrophil to lymphocyte ratio （NLR） was 3.15 （AUC=0.65， 95%CI： 0.54-0.73）， with a specificity of 92.31% and a sensitivity of 43.97%. The optimal cut-off value for the platelet to lymphocyte ratio （PLR） was 137.36 （AUC=0.59， 95%CI： 0.51-0.68）， with a specificity of 93.66% and a sensitivity of 34.98%. The optimal cut-off value for lymphocyte to monocyte ratio （LMR） was 5.18 （AUC=0.69， 95%CI： 0.58-0.76）， with a specificity of 61.29% and a sensitivity of 73.33%. The optimal cut-off value for panimmune inflammation value （PIV） was 276.57 （AUC=0.73， 95%CI： 0.65-0.78）， with a specificity of 78.41% and a sensitivity of 59.77%. The optimal cut-off value for the systemic immune inflammatory index （SII） was 654.37 （AUC=0.73， 95%CI： 0.66-0.78）， with a specificity of 86.32% and a sensitivity of 62.11%. The optimal cut-off value for the IBI was 49.12 （AUC=0.82， 95%CI： 0.79-0.92）， with a specificity of 85.36% and a sensitivity of 65.82%. LASSO regression analysis showed that there were 8 prognostic variables related to survival， including IBI， T stage， N stage， age， carcinoembryonic antigen（CEA）， SII， PIV， and tumor grade. The results of univariate analysis showed that IBI （HR=4.57， 95%CI： 3.82-5.32， P<0.001）， T stage （HR=2.54， 95%CI： 1.75-3.31， P<0.001）， N stage （HR=1.69， 95%CI： 1.15-2.21， P=0.032）， CEA （HR=1.38， 95%CI： 1.06-1.75， P=0.032）， and tumor grade （HR=1.87， 95%CI： 1.34-2.59， P=0.026） were prognostic factors for gastric cancer patients. The results of multivariate analysis showed that IBI （HR=3.96， 95%CI： 3.51-4.48， P<0.001）， T stage （HR=2.31， 95%CI： 1.63-3.02， P=0.023）， tumor grade （HR=1.49， 95%CI： 1.12-1.83， P=0.042） were independent risk factors affecting the prognosis of gastric cancer patients. Compared with low-level IBI gastric cancer patients， the risk of death in high-level IBI patients was up to 3.96 times. Conclusion IBI may be an important marker for diagnosis and prognosis prediction of gastric cancer， which has certain scientific and clinical value in the diagnosis and treatment of gastric cancer.

Key words: Inflammatory burden index, Stomach neoplasms, Prognosis