Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 20 (1), 11

Complete Blood Count-Based Inflammatory Score (CBCS) Is a Novel Prognostic Marker for Gastric Cancer Patients After Curative Resection


Complete Blood Count-Based Inflammatory Score (CBCS) Is a Novel Prognostic Marker for Gastric Cancer Patients After Curative Resection

Jian-Xian Lin et al. BMC Cancer.


Background: We sought to investigate the prognostic value of complete blood count (CBC)-based biomarkers for patients with resectable gastric cancer (GC).

Methods: Patients with GC who underwent primary surgical resection between December 2008 and December 2013 were included. The estimated area under the curve (AUC) and multivariate Cox regression models were used to identify the best CBC-based biomarker. Time-dependent receiver operating characteristic (t-ROC) curve analysis was used to predict overall survival and compare the prognostic impact.

Results: In the 1810 patients analyzed, the median follow-up period was 51.0 months (range 1-101 months). Based on multivariate analysis, the lymphocyte-monocyte ratio (LMR) and hemoglobin (Hb) level were independent prognostic factors (both P < 0.05). Based on the LMR and Hb level, we established the CBC-based inflammatory score (CBCS). A higher CBCS was associated with older age, female sex, higher American Society of Anesthesiologists (ASA) score, proximal tumor location, larger tumor size, later stage and vascular involvement (all P < 0.05). Univariate analyses showed that a higher CBCS was also associated with worse overall survival (OS), which was consistent in each stage (all P < 0.05). Multivariate analysis revealed that the CBCS was a significant independent biomarker (P < 0.05). The AUC for the CBCS (0.627) was significantly higher than the AUCs for the LMR (0.573) and Hb level (0.605) (both P < 0.05). Furthermore, the t-ROC curve of the CBCS was superior to that of the prognostic nutritional index (PNI), systemic immune-inflammation index (SII), modified Glasgow prognostic score (mGPS) and C-reactive protein/albumin ratio (CRP/Alb) throughout the observation period.

Conclusion: The preoperative LMR and Hb level were optimal CBC-based biomarkers for predicting OS in GC patients after curative resection. Based on the LMR and Hb, we developed a novel and easily obtainable prognostic score called the CBCS, which may improve the prediction of clinical outcomes.

Keywords: Biomarker; Complete blood count; Gastric cancer; Prognosis.

Conflict of interest statement

There are no conflicts of interest or financial ties to disclose for any of the authors.


Fig. 1
Fig. 1
Kaplan-Meier analysis of overall survival according to SIS in the (a) total cohort and (b) stage I, (c) stage II, and (d) stage III subgroups
Fig. 2
Fig. 2
Time-dependent ROC curves of the CBCS, PNI, and SII for the prediction of overall survival. The dotted lines in Fig. 2 represent the 95% CI, and the unit of time is months. Blood samples were routinely drawn during the 7 days before surgery

Similar articles

See all similar articles


    1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;5:E359–E386. doi: 10.1002/ijc.29210. - DOI - PubMed
    1. Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with Para-aortic nodal dissection for gastric Cancer. N Engl J Med. 2008;5:453–462. doi: 10.1056/NEJMoa0707035. - DOI - PubMed
    1. Balkwill F, Mantovani A. Inflammation and Cancer: Back to Virchow? Lancet. 2001;9255:539–545. doi: 10.1016/S0140-6736(00)04046-0. - DOI - PubMed
    1. Coussens LM, Werb Z. Inflammation and Cancer. Nature. 2002;6917:860–867. doi: 10.1038/nature01322. - DOI - PMC - PubMed
    1. Bhindi B, Hermanns T, Wei Y, et al. Identification of the best complete blood count-based predictors for bladder Cancer outcomes in patients undergoing radical cystectomy. Br J Cancer. 2016;2:207–212. doi: 10.1038/bjc.2015.432. - DOI - PMC - PubMed

LinkOut - more resources