Systemic inflammation score: a novel risk stratification tool for postoperative outcomes after video-assisted thoracoscopic surgery lobectomy for early-stage non-small-cell lung cancer

• Main Authors: Li S, Wang Z, Zhang W, Li J, Zhou K, Che G
• Format: Article
• Language: English
• Published: Dove Medical Press 2019-06-01
• Series: Cancer Management and Research
• Subjects: Systemic inflammation score; Video-assisted thoracoscopic surgery; Morbidity; Prediction
• Online Access: https://www.dovepress.com/systemic-inflammation-score-a-novel-risk-stratification-tool-for-posto-peer-reviewed-article-CMAR

Shuangjiang Li,1,* Zhiqiang Wang,2,* Wenbiao Zhang,1 Jue Li,1 Kun Zhou,1 Guowei Che11Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, People’s Republic of China; 2Department of Thoracic Surgery, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing University, Chongqing 400030, People’s Republic of China*These authors contributed equally to this work Objectives: To evaluate whether the systemic inflammation score (SIS) could predict postoperative outcomes for patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for early-stage non-small-cell lung cancer (NSCLC).Methods: This retrospective study was conducted on the prospectively maintained database in our institution between January 2016 and December 2017. Preoperative SIS comprising serum albumin (sALB) and lymphocyte-to-monocyte ratio (LMR) was graded into 0, 1 and 2, and then utilized to distinguish patients at high surgical risks. Multivariable logistic-regression analysis was conducted to determine independent risk factors for postoperative outcomes.Results: There were 1,025 patients with TNM-stage I-II NSCLC included, with an overall morbidity rate of 31.1% and mortality rate of 0.3%. We applied the sALB at 40 g/L and the median LMR of our series at 4.42 as dichotomized cutoffs for modified SIS scoring criteria. Both minor and major morbidity rates in patients with SIS=2 were significantly higher than those in patients with SIS=0 and with SIS=1 (P<0.001). No difference was found in overall morbidity rate between patients with SIS=1 and with SIS=0 (P=0.20). No significant difference was found in the mortality rate between these 3 groups. Patients with SIS=2 had the highest probability to experience most of individual complications. Finally, multivariable logistic-regression analysis suggested that preoperative SIS=2 could independently predict the morbidity risks following VATS lobectomy (OR=1.73; 95% CI=1.11–2.71; P=0.016).Conclusions: The SIS scoring system can be employed as a simplified, effective and routinely operated risk stratification tool in patients undergoing VATS lobectomy. Keywords: systemic inflammation score, video-assisted thoracoscopic surgery, non-small-cell lung cancer, prediction