The prognostic significance of the comprehensive complication index in patients with gastric cancer

Purpose Postoperative complications worsen the prognosis of gastric cancer patients. The Clavien-Dindo classification is used to evaluate postoperative complications. The prognostic significance of the comprehensive complication index (CCI), a new tool for evaluating postoperative complications, remains unclear. Methods This study included 452 gastric adenocarcinoma patients who underwent curative surgery. Results The CCI values were significantly higher in older patients ( >= 70 years; P < 0.0001), male patients (P < 0.0001), those with lymphatic invasion (P = 0.039), and those with vascular invasion (P = 0.037). The five-year overall survival (OS) and disease-specific survival (DSS) rates were significantly higher in patients without postoperative complications and those with Clavien-Dindo grade 1 complications in comparison to those with Clavien-Dindo grade 2-4 complications (80.4% vs. 66.2%, P = 0.0011; 89.7% vs. 82.3%; P = 0.045, respectively). Among patients with Clavien-Dindo grade 2-4 complications, the 5-year OS and DSS rates in the CCIHigh group ( >= 32.15) were significantly lower than those in the CCILow group ( < 32.15; 47.5% vs. 74.9%, P = 0.0086; 63.1% vs. 90.0%, P = 0.0003). A multivariate analysis identified the CCI as an independent prognostic indicator in patients with Clavien-Dindo grade 2-4 complications. Conclusions The CCI was closely associated with the prognosis of patients with Clavien-Dindo grade 2-4 complications and may be a prognostic indicator.