Prognostic impact of postoperative fixed-point inflammation in patients with gastric cancer after curative gastrectomy: A validation cohort study.

[BACKGROUND] This study aimed to determine the cutoff values of C-reactive protein (CRP) on postoperative day 3 to predict poor overall survival (OS) in men and women with gastric cancer after radical gastrectomy.

[METHODS] This retrospective cohort study included consecutive patients who underwent radical gastrectomy for primary pStages I-III gastric cancer between May 2006 and March 2017. The patients were randomly divided 6:4 into a training set, which examined the cutoff values for CRP, and a validation set, which validated the cutoff values. Patients with a CRP level higher than the cutoff value were defined as the high-CRP group, and those with a CRP level lower than the cutoff value were defined as the low-CRP group. We compared the OS of the high and low CRP groups using the log-rank test and identified prognostic factors using Cox proportional hazards regression analysis.

[RESULTS] We examined the cutoff values of CRP, which were 19.1 mg/dL for men and 8.1 mg/dL for women. The median follow-up duration was 66 months. The high-CRP group had poorer OS than the low-CRP group ( < 0.001). Multivariate analyses showed that a high CRP level was an independent poor prognostic factor for OS in all patients (hazard ratio, 1.356; 95% confidence interval, 1.168-1.576;  < 0.001), not only in patients without postoperative complications ( = 0.001) but also in patients with postoperative complications ( = 0.023).

[CONCLUSION] This study demonstrated that a high postoperative CRP was an independent poor prognostic factor for OS in patients with gastric cancer after radical gastrectomy.