Systemic immune–inflammation index as a useful prognostic indicator predicts survival in patients with advanced gastric cancer treated with neoadjuvant chemotherapy

Figures & data

Table 1 Demographic and clinicopathologic characteristics of 292 patients with gastric cancer

Parameters	NCT			P-value	NNCT			P-value
	Low SII <600	High SII ≥600	χ^2		Low SII <600	High SII ≥600	χ^2
Cases (n)	52	55			117	68
Age (years)			2.732	0.098			0.558	0.455
<57	31	24			60	31
≥57	21	31			57	37
Gender			3.098	0.078			5.119	0.024
Male	36	46			86	39
Female	16	9			31	29
BMI			0.753	0.386
<22.10	28	25
≥22.10	24	30
ABO blood type			0.451	0.930			2.880	0.411
A	16	14			32	15
B	17	19			33	27
O	14	17			37	17
AB	5	5			15	9
Radical resection			1.809	0.405			1.792	0.426
R0	30	30			100	53
R1	9	15			10	9
R2	13	10			7	6
Type of surgery			0.159	0.924*			1.078	0.583
Distal gastrectomy	30	30			79	42
Proximal gastrectomy	3	4			10	5
Total gastrectomy	19	21			28	21
Differentiation			0.042	0.979*			0.417	0.812*
Poorly differentiated	32	33			72	39
Moderately differentiated	17	19			44	28
Well differentiated	3	3			1	1
Primary tumor site			3.005	0.223*			3.918	0.141
Upper one third	3	6			12	5
Middle one third	16	23			38	32
Lower one third	33	26			67	31
Pathology			4.417	0.353*			5.418	0.144*
Normal (Tis)	7	2			0	0
Adenocarcinoma	26	35			82	44
Mucinous carcinoma	4	4			7	11
Signet ring cell carcinoma	7	5			22	11
Mixed carcinoma	8	9			6	2
Clinical TNM classification
T stage			0.068	0.795*
T3	4	5
T4	48	50
N stage			5.554	0.062*
N0	14	16
N1	33	39
N2	5	0
TNM stage			1.051	0.305
II	9	14
III	43	41
Pathologic TNM classification
T stage			5.378	0.251*			3.812	0.432*
Tis+T1	10	7			3	3
T2	0	3			15	3
T3	21	21			23	14
T4a	12	9			67	42
T4b	9	15			9	6
N stage			6.368	0.173			10.480	0.033
N0	18	14			17	10
N1	13	10			24	9
N2	5	13			32	19
N3a	10	15			36	15
N3b	6	3			8	15
Metastasis			0.403	0.525*			0.031	0.860*
M0	50	54			113	66
M1	2	1			4	2
TNM stage			1.503	0.682*			0.136	0.987*
Tis+I	9	6			5	3
II	15	16			21	11
III	26	32			87	52
IV	2	1			4	2
Total lymph nodes			0.031	0.861			1.057	0.304
<22	19	21			71	36
≥22	33	34			46	32
Positive lymph nodes			0.972	0.615			1.228	0.541
0	18	15			17	9
<5	14	14			39	18
≥5	20	26			61	41
CEA (ng/mL)			4.114	0.043			0.004	0.950
<2.72	31	22			70	41
≥2.72	21	33			47	27
CA19-9 (U/mL)			0.231	0.631			3.962	0.047
<12.12	27	26			71	31
≥12.12	25	29			46	37
Lauren classification			1.636	0.441			4.950	0.084*
Intestinal	26	31			82	44
Diffuse	18	13			4	8
Mixed	8	11			31	16
Borrmann classification			2.860	0.414*			0.195	0.978*
Borrmann I	1	0			6	3
Borrmann II	14	10			15	10
Borrmann III	29	38			83	47
Borrmann IV	8	7			13	8
Tumor size (mm)			0.092	0.761			9.329	0.002
<50	28	28			52	15
≥50	24	27			65	53

Notes:

* Fisher’s exact test. SII is a novel systemic immune–inflammation index (SII=N×P/L), which is based on neutrophil (N), platelet (P) and lymphocyte (L) counts.

Abbreviations: BMI, body mass index; NCT, neoadjuvant chemotherapy; NNCT, non-neoadjuvant chemotherapy; CA19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen.

Table 2 Correlation between SII and hematologic parameters

Parameters	NCT			P-value	NNCT			P-value
	Low SII <600	High SII ≥600	χ^2		Low SII <600	High SII ≥600	χ^2
Cases (n)	52	55			117	68
White blood cell (W)			15.680	<0.001			6.578	0.010
<6.17	33	14			71	28
≥6.17	19	41			46	40
Hb			6.765	0.009			16.530	<0.001
<126	24	39			38	43
≥126	28	16			79	25
Neutrophils (N)			28.230	<0.001			28.660	<0.001
<3.74	39	13			77	17
≥3.74	13	42			40	51
Monocyte (M)			2.058	0.151			1.146	0.284
<0.42	21	15			68	34
≥0.42	31	40			49	34
Platelet (P)			19.190	<0.001			18.100	<0.001
<262	32	11			79	24
≥262	20	44			38	44
Lymphocyte (L)			0.448	0.503			17.090	<0.001
<1.74	25	30			44	47
≥1.74	27	25			73	21
NLR			29.340	<0.001*			44.610	<0.001
<1.65	24	1			57	1
≥1.65	28	54			60	67
MLR			67.501	<0.001			6.600	0.010
<0.17	46	5			35	9
≥0.17	6	50			82	59
PLR			33.400	<0.001*			47.790	<0.001
<133	28	2			77	9
≥133	24	53			40	59

Notes:

* Fisher’s exact test. SII is a novel systemic immune–inflammation index (SII=N×P/L), which is based on neutrophil (N), platelet (P) and lymphocyte (L) counts.

Abbreviations: Hb, hemoglobin; MLR, monocyte to lymphocyte ratio; NCT, neoadjuvant chemotherapy; NLR, neutrophil to lymphocyte ratio; NNCT, non-neoadjuvant chemotherapy; PLR, platelet to lymphocyte ratio.

Table 3 Univariate and multivariate Cox regression survival analyses of the SII for the prediction of DFS and OS in patients with gastric cancer

Parameters	DFS			P-value	OS			P-value
	Univariate analysis	P-value	Multivariate analysis		Univariate analysis	P-value	Multivariate analysis
	Hazard ratio (95% CI)		Hazard ratio (95% CI)		Hazard ratio (95% CI)		Hazard ratio (95% CI)
Age (years)		0.628				0.595
<57	1 (reference)				1 (reference)
≥57	1.091 (0.767–1.553)				1.104 (0.766–1.590)
Gender		0.962				0.998
Male	1 (reference)				1 (reference)
Female	1.010 (0.668–1.527)				1.001 (0.662–1.512)
ABO blood type		0.365				0.301
A	1 (reference)				1 (reference)
B	1.165 (0.736–1.844)				1.023 (0.644–1.625)
O	0.768 (0.490–1.204)				0.684 (0.430–1.089)
AB	0.966 (0.520–1.794)				0.921 (0.501–1.693)
Radical resection		<0.001		<0.001		<0.001		<0.001
R0	1 (reference)		1 (reference)		1 (reference)		1 (reference)
R1	1.349 (0.825–2.204)		1.254 (0.810–1.941)		1.249 (0.802–1.946)		1.250 (0.812–1.923)
R2	6.477 (3.730–11.248)		6.402 (3.930–10.429)		5.573 (3.589–8.655)		5.096 (3.338–7.780)
Type of surgery		0.051				0.078
Distal gastrectomy	1 (reference)				1 (reference)
Proximal gastrectomy	1.186 (0.433–3.245)				1.110 (0.391–3.155)
Total gastrectomy	1.872 (1.109–3.161)				1.801 (1.056–3.070)
Differentiation		0.265				0.383
Poorly differentiated	1 (reference)				1 (reference)
Moderately differentiated	1.384 (0.930–2.059)				1.275 (0.903–1.801)
Well differentiated	1.066 (0.304–2.893)				1.039 (0.370–2.920)
Primary tumor site		0.316				0.664
Upper one third	1 (reference)				1 (reference)
Middle one third	0.693 (0.309–1.552)				0.831 (0.355–1.941)
Low one third	0.977 (0.403–2.369)				1.041 (0.421–2.575)
Pathology		0.070				0.104
Normal (Tis)+adenocarcinoma	1 (reference)				1 (reference)
Mucinous carcinoma	1.900 (1.161–3.109)				1.845 (1.128–3.019)
Signet ring cell carcinoma	1.275 (0.820–1.983)				1.212 (0.783–1.874)
Mixed carcinoma	0.978 (0.561–1.704)				1.027 (0.587–1.797)
Pathologic TNM classification
T stage		0.008		0.006		0.007		0.003
Tis+T1	1 (reference)		1 (reference)		1 (reference)		1 (reference)
T2	1.403 (0.334–5.891)		1.411 (0.341–5.847)		1.449 (0.347–6.052)		1.415 (0.345–5.794)
T3	2.274 (0.475–10.880)		2.616 (0.560–12.222)		2.674 (0.571–12.516)		3.313 (0.725–15.150)
T4a	1.859 (0.383–9.010)		1.992 (0.417–9.519)		2.075 (0.437–9.859)		2.358 (0.503–11.054)
T4b	4.286 (0.825–22.279)		4.503 (0.873–23.223)		4.737 (0.931–24.101)		5.347 (1.061–26.952)
N stage		<0.001		<0.001		<0.001		<0.001
N0	1 (reference)		1 (reference)		1 (reference)		1 (reference)
N1	1.329 (0.523–3.379)		2.095 (1.089–4.031)		1.653 (0.662–4.130)		2.143 (1.114–4.122)
N2	2.917 (1.055–8.065)		3.809 (2.102–6.903)		3.813 (1.387–10.485)		3.983 (2.198–7.219)
N3a	3.489 (1.255–9.700)		5.146 (2.874–9.214)		4.725 (1.701–13.120)		5.245 (2.931–9.385)
N3b	5.448 (1.933–15.357)		9.590 (5.064–18.160)		7.448 (2.648–20.945)		9.325 (5.449–19.565)
M stage		<0.001		<0.001		<0.001		<0.001
M0	1 (reference)		1 (reference)		1 (reference)		1 (reference)
M1	3.645 (1.889–8.323)		4.152 (1.907–9.040)		2.145 (1.940–6.988)		4.845 (2.181–10.763)
TNM stage		<0.001		<0.001		<0.001		<0.001
Tis+I	1 (reference)		1 (reference)		1 (reference)		1 (reference)
II	2.719 (0.618–11.969)		3.052 (0.709–13.143)		2.785 (0.636–12.205)		3.320 (0.773–14.264)
III	10.267 (2.497–42.211)		10.998 (2.717–44.525)		10.712 (2.611–43.942)		9.091 (2.991–38.883)
IV	6.545 (2.352–10.446)		9.843 (6.520–15.897)		4.256 (2.118–8.555)		8.813 (6.503–14.996)
Total lymph nodes		0.013		0.006		0.001		0.001
<22	1 (reference)		1 (reference)		1 (reference)		1 (reference)
≥22	1.488 (1.086–2.037)		1.544 (1.135–2.099)		1.669 (1.217–2.290)		1.670 (1.228–2.272)
Positive lymph nodes		<0.001		<0.001		<0.001		<0.001
0	1 (reference)		1 (reference)		1 (reference)		1 (reference)
<5	2.240 (1.226–4.095)		2.235 (1.222–4.086)		2.280 (1.247–4.169)		2.314 (1.266–4.231)
≥5	5.189 (2.970–9.066)		5.435 (3.115–9.481)		5.303 (3.036–9.262)		5.448 (3.120–9.514)
CEA (ng/mL)		0.212				0.239
<2.72	1 (reference)				1 (reference)
≥2.72	1.265 (0.875–1.828)				1.249 (0.862–1.809)
CA19-9 (U/mL)		0.655				0.658
<12.12	1 (reference)				1 (reference)
≥12.12	1.086 (0.757–1.559)				1.087 (0.753–1.568)
Lauren classification		0.218				0.210
Intestinal	1 (reference)				1 (reference)
Diffuse	2.361 (0.873–6.386)				2.461 (0.885–6.847)
Mixed	1.638 (0.801–3.348)				1.643 (0.804–3.359)
Borrmann classification		0.005		0.006		0.002		0.006
Borrmann I	1 (reference)		1 (reference)		1 (reference)		1 (reference)
Borrmann II	0.912 (0.294–2.831)		0.891 (0.324–2.451)		1.061 (0.336–3.354)		0.944 (0.341–2.611)
Borrmann III	0.385 (0.183–0.810)		0.399 (0.215–0.742)		0.348 (0.165–0.735)		0.415 (0.222–0.777)
Borrmann IV	1.038 (0.590–1.827)		0.973 (0.627–1.510)		0.990 (0.562–1.743)		1.032 (0.654–1.600)
Tumor size (mm)		0.185				0.502
<50	1 (reference)				1 (reference)
≥50	1.307 (0.879–1.943)				1.148 (0.768–1.716)
Chemotherapy regimen (after)		0.215				0.239
SOX	1 (reference)				1 (reference)
XELOX	0.892 (0.406–1.956)				0.877 (0.392–1.961)
Others	1.338 (0.626–2.857)				1.285 (0.589–2.801)
No	2.689 (0.434–16.656)				2.878 (0.420–19.749)
Postoperative chemotherapy times		0.553				0.792
0	1 (reference)				1 (reference)
<4	2.066 (0.363–11.761)				1.885 (0.300–11.829)
≥4	2.264 (0.406–12.627)				1.782 (0.297–10.708
White blood cells (×10^9/L)		0.681				0.619
<6.17	1 (reference)				1 (reference)
≥6.17	1.146 (0.598–2.195)				1.187 (0.604–2.332)
Hemoglobin (×10^9/L)		0.738				0.892
<126	1 (reference)				1 (reference)
≥126	1.073 (0.709–1.624)				1.029 (0.679–1.560)
Neutrophils (×10^9/L)		0.539				0.329
<3.74	1 (reference)				1 (reference)
≥3.74	1.234 (0.631–2.412)				1.412 (0.706–2.826)
Monocytes (×10^9/L)		0.624				0.298
<0.42	1 (reference)				1 (reference)
≥0.42	1.124 (0.704–1.794)				1.279 (0.805–2.034)
Platelets (×10^9/L)		0.516				0.876
<262	1 (reference)				1 (reference)
≥262	1.171 (0.728–1.883)				1.039 (0.640–1.688)
Lymphocytes (×10^9/L)		0.003		0.002		0.001		0.002
<1.74	1 (reference)		1 (reference)		1 (reference)		1 (reference)
≥1.74	0.455 (0.271–0.764)		0.606 (0.443–0.830)		0.408 (0.239–0.696)		0.609 (0.445–0.833)
NLR		0.546				0.862
<1.65	1 (reference)				1 (reference)
≥1.65	1.139 (0.746–1.739)				1.038 (0.678–1.592)
MLR		0.057				0.077
<0.17	1 (reference)				1 (reference)
≥0.17	1.522 (0.987–2.342)				1.477 (0.958–2.283)
PLR		0.988				0.872
<133	1 (reference)				1 (reference)
≥133	1.003 (0.686–1.466)				1.032 (0.700–1.524)
SII (×10^9/L)		0.020		0.003		0.028		0.002
<600	1 (reference)		1 (reference)		1 (reference)		1 (reference)
≥600	1.607 (1.076–2.398)		1.574 (1.161–2.134)		1.574 (1.049–2.361)		1.637 (1.194–2.245)

Note: SII is a novel systemic immune–inflammation index (SII=N×P/L), which is based on neutrophil (N), platelet (P) and lymphocyte (L) counts.

Abbreviations: CEA, carcinoembryonic antigen; CA19-9, carbohydrate antigen 19-9; DFS, disease-free survival; OS, overall survival; MLR, monocyte to lymphocyte ratio; NLR, neutrophil to lymphocyte ratio; PLR, platelet to lymphocyte ratio; SOX, S-1 and oxaliplatin; XELOX, oxaliplatin and capecitabine.

Figure 1 DFS and OS of patients with gastric cancer.

Notes: (A) Kaplan–Meier analysis of DFS of all patients with gastric cancer. (B) Kaplan–Meier analysis of OS of all patients with gastric cancer. (C) Kaplan–Meier analysis of DFS for the SII of all patients with gastric cancer. (D) Kaplan–Meier analysis of OS for the SII of all patients with gastric cancer. (E) Kaplan–Meier analysis of DFS for the SII of patients with gastric cancer in the NCT group. (F) Kaplan–Meier analysis of OS for the SII of patients with gastric cancer in the NCT group. (G) Kaplan–Meier analysis of DFS for the SII of patients with gastric cancer in the NNCT group. (H) Kaplan–Meier analysis of OS for the SII of patients with gastric cancer in the NNCT group. SII is a novel systemic immune–inflammation index (SII=N×P/L), which is based on neutrophil (N), platelet (P) and lymphocyte (L) counts.
Abbreviations: DFS, disease-free survival; NCT, neoadjuvant chemotherapy; NNCT, non-neoadjuvant chemotherapy; OS, overall survival.

Table 4 1-, 3- and 5-year DFS and OS rates of patients with gastric cancer

Parameters	Cases (n)	DFS			OS
		1 year (%)	3 years (%)	5 years (%)	1 year (%)	3 years (%)	5 years (%)
NCT+NNCT	292
Low SII	169	132 (78.1)	72 (42.6)	54 (32.0)	149 (88.2)	81 (47.9)	58 (34.3)
High SII	123	89 (72.4)	39 (31.7)	29 (23.6)	100 (81.3)	43 (35.0)	31 (25.2)
χ^2		1.278	3.587	2.455	2.672	4.901	2.792
P value		0.258	0.058	0.117	0.102	0.027	0.095
NCT	107
Low SII	52	40 (76.9)	15 (28.8)	6 (11.5)	45 (86.5)	16 (30.8)	8 (15.4)
High SII	55	38 (69.1)	11 (20.0)	4 (7.3)	46 (83.6)	12 (21.8)	5 (9.1)
χ^2		0.830	1.137	0.574	0.177	1.108	0.992
P value		0.362	0.286	0.519	0.674	0.292	0.319
NNCT	185
Low SII	117	92 (78.6)	57 (48.7)	48 (41.0)	104 (88.9)	65 (55.6)	50 (42.7)
High SII	68	51 (75.0)	28 (41.2)	25 (36.8)	54 (79.4)	31 (45.6)	26 (38.2)
χ^2		0.323	0.985	0.327	3.099	1.711	0.360
P value		0.570	0.321	0.568	0.078	0.191	0.549

Note: SII is a novel systemic immune–inflammation index (SII=N×P/L), which is based on neutrophil (N), platelet (P) and lymphocyte (L) counts.

Abbreviations: DFS, disease-free survival; NCT, neoadjuvant chemotherapy; NNCT, non-neoadjuvant chemotherapy; OS, overall survival.

Figure 2 The 1-, 3- and 5-year rates of DFS and OS in patients with gastric cancer.

Notes: (A): The 1-, 3- and 5-year rates of DFS in all patients with gastric cancer. (B) The 1-, 3- and 5-year rates of OS in all patients with gastric cancer. (C) The 1-, 3- and 5-year rates of DFS in the NCT group. (D) The 1-, 3- and 5-year rates of OS in the NCT group. (E) The 1-, 3- and 5-year rates of DFS in the NNCT group. (F) The 1-, 3- and 5-year rates of OS in the NNCT group.
Abbreviations: DFS, disease-free survival; NCT, neoadjuvant chemotherapy; NNCT, non-neoadjuvant chemotherapy; OS, overall survival.

Figure 3 DFS and OS for the SII of patients with gastric cancer in pathologic stage.

Notes: (A) Kaplan–Meier analysis of DFS for the SII of patients with gastric cancer in early stage gastric cancer. (B) Kaplan–Meier analysis of OS for the SII of patients with gastric cancer in early stage gastric cancer. (C) Kaplan–Meier analysis of DFS for the SII of patients with gastric cancer in advanced stage gastric cancer. (D) Kaplan–Meier analysis of OS for the SII of patients with gastric cancer in advanced stage gastric cancer. (E) Kaplan–Meier analysis of DFS for the SII of patients with gastric cancer in pathologic II stage. (F) Kaplan–Meier analysis of OS for the SII of patients with gastric cancer in pathologic II stage. (G) Kaplan–Meier analysis of DFS for the SII of patients with gastric cancer in pathologic III stage. (H) Kaplan–Meier analysis of OS for the SII of patients with gastric cancer in pathologic III stage. (I) Kaplan–Meier analysis of DFS for the SII of patients with gastric cancer in pathologic IV stage. (J) Kaplan–Meier analysis of OS for the SII of patients with gastric cancer in pathologic IV stage. SII is a novel systemic immune–inflammation index (SII=N×P/L), which is based on neutrophil (N), platelet (P) and lymphocyte (L) counts.
Abbreviations: DFS, disease-free survival; OS, overall survival.

Table 5 Correlation between SII and neoadjuvant chemotherapy or postoperative chemotherapy of patients with gastric cancer

Parameters	NCT			P-value	NNCT			P-value
	Low SII <600	High SII ≥600	χ^2		Low SII <600	High SII ≥600	χ^2
Cases (n)	52	55			117	68
Chemotherapy regimen (before)			0.442	0.802
SOX	20	15
XELOX	26	30
Others	6	10
Preoperative chemotherapy times			1.636	0.201
<3	31	26
≥3	21	29
Chemotherapy regimen (after)			2.348	0.503			0.976	0.807*
SOX	19	13			2	1
XELOX	19	22			37	17
Othersa	8	12			54	34
No	6	8			24	16
Postoperative chemotherapy times			0.317	0.854			3.420	0.181
0	6	8			24	16
<4	26	25			29	24
≥4	20	22			64	28
Response			4.512	0.211*
CR	7	2
PR	35	37
SD	2	5
PD	8	11

Notes:

* Fisher’s exact test.

a Others include TS (paclitaxel and S-1), FOLFOX (folinic, oxaliplatin and fluorouracil), TCF (paclitaxel, cisplatin and fluorouracil), ECF (epirubicin, cisplatin and fluorouracil), TF (docetaxel and fluorouracil), DCF (docetaxel, cisplatin and fluorouracil) and other fluoropyrimidine-based adjuvant chemotherapy. SII is a novel systemic immune–inflammation index (SII=N×P/L), which is based on neutrophil (N), platelet (P) and lymphocyte (L) counts.

Abbreviations: CR, complete response; NCT, neoadjuvant chemotherapy; NNCT, non-neoadjuvant chemotherapy; PD, progression of disease; PR, partial response; SD, stable disease; SOX, S-1 and oxaliplatin; XELOX, oxaliplatin and capecitabine.

Figure 4 DFS and OS of patients with gastric cancer receiving neoadjuvant chemotherapy and postoperative chemotherapy in the NCT group.

Notes: Patients receiving neoadjuvant chemotherapy and postoperative chemotherapy form the A group and those receiving neoadjuvant chemotherapy but not postoperative chemotherapy form the B group. (A) Kaplan–Meier analysis of DFS for the SII of patients with gastric cancer receiving neoadjuvant chemotherapy and postoperative chemotherapy. (B) Kaplan–Meier analysis of OS for the SII of patients with gastric cancer receiving neoadjuvant chemotherapy and postoperative chemotherapy. (C) Kaplan–Meier analysis of DFS for low SII of patients with gastric cancer receiving neoadjuvant chemotherapy and postoperative chemotherapy. (D) Kaplan–Meier analysis of OS for low SII of patients with gastric cancer receiving neoadjuvant chemotherapy and postoperative chemotherapy. (E) Kaplan–Meier analysis of DFS for high SII of patients with gastric cancer receiving neoadjuvant chemotherapy and postoperative chemotherapy. (F) Kaplan–Meier analysis of OS for high SII of patients with gastric cancer receiving neoadjuvant chemotherapy and postoperative chemotherapy. SII is a novel systemic immune–inflammation index (SII=N×P/L), which is based on neutrophil (N), platelet (P) and lymphocyte (L) counts.
Abbreviations: DFS, disease-free survival; NCT, neoadjuvant chemotherapy; OS, overall survival.

Figure 5 DFS and OS of patients with gastric cancer receiving postoperative chemotherapy in the NNCT group.

Notes: Patients receiving postoperative chemotherapy form the C group and those not receiving postoperative chemotherapy form the D group. (A) Kaplan–Meier analysis of DFS for the SII of patients with gastric cancer receiving postoperative chemotherapy. (B) Kaplan–Meier analysis of OS for the SII of patients with gastric cancer receiving postoperative chemotherapy. (C) Kaplan–Meier analysis of DFS for low SII of patients with gastric cancer receiving postoperative chemotherapy. (D) Kaplan–Meier analysis of OS for low SII of patients with gastric cancer receiving postoperative chemotherapy. (E) Kaplan–Meier analysis of DFS for high SII of patients with gastric cancer receiving postoperative chemotherapy. (F) Kaplan–Meier analysis of OS for high SII of patients with gastric cancer receiving postoperative chemotherapy. SII is a novel systemic immune–inflammation index (SII=N×P/L), which is based on neutrophil (N), platelet (P) and lymphocyte (L) counts.
Abbreviations: DFS, disease-free survival; NNCT, non-neoadjuvant chemotherapy; OS, overall survival.

Table 6 Main toxicities according to NCI-CTC scale of the patients with gastric cancer undergoing neoadjuvant chemotherapy

Toxicity		NCT group			P-value
		Low SII <600	High SII ≥600	χ^2
Cases (n)	107	52	55
Anemia
Grade 0	71 (66.4%)	40 (76.9%)	31 (56.4%)	5.061	0.080
Grade 1–2	33 (30.8%)	11 (21.2%)	22 (40.0%)
Grade 3–4	3 (2.8%)	1 (1.9%)	2 (3.6%)
Leukopenia
Grade 0	84 (78.5%)	36 (69.2%)	48 (87.3%)	5.156	0.023
Grade 1–2	23 (21.5%)	16 (30.8%)	7 (12.7%)
Grade 3–4	0 (0.0%)	0 (0.0%)	0 (0.0%)
Neutropenia
Grade 0	77 (72.0%)	32 (61.5%)	45 (81.8%)	5.687	0.058
Grade 1–2	28 (26.2%)	19 (36.5%)	9 (16.4%)
Grade 3–4	2 (1.8%)	1 (2.0%)	1 (1.8%)
Thrombocytopenia
Grade 0	94 (87.9%)	44 (84.6%)	50 (90.9%)	0.992	0.319
Grade 1–2	13 (12.1%)	8 (15.4%)	5 (9.1%)
Grade 3–4	0 (0.0%)	0 (0.0%)	0 (0.0%)
Myelosuppression
Yes	53 (49.5%)	26 (50.0%)	27 (49.1%)	0.009	0.925
No	54 (50.5%)	26 (50.0%)	28 (50.9%)
Gastrointestinal reaction
Yes	89 (83.2%)	45 (86.5%)	44 (80.0%)	0.817	0.366
No	18 (16.8%)	7 (13.5%)	11 (20.0%)

Note: SII is a novel systemic immune–inflammation index (SII=N×P/L), which is based on neutrophil (N), platelet (P) and lymphocyte (L) counts.

Abbreviations: NCI-CTC, National Cancer Institute Common Toxicity Criteria; NCT, neoadjuvant chemotherapy.