Significance of prognostic nutritional index combined with inflammatory index in predicting prognosis of locally advanced gastric cancer with concurrent chemoradiotherapy

YAO Xuepin; DUAN Yingxin; HUO Junjie

doi:10.3969/j.issn.1009-0460.2024.08.006

Abstract：Objective To investigate the significance of prognostic nutritional index(PNI)and systemic inflammatory index before concurrent chemoradiotherapy(CCRT)in patients with locally advanced gastric cancer(LAGC).Methods The medical records of 120 patients with locally advanced gastric or gastroesophageal borderline carcinoma who received D2 radical resection and auxiliary CCRT from January 2019 to December 2020 were retrospectively analyzed.Receiver operating characteristics(ROC)determined the best cut-off values for relevant indicators to predict recurrence and death.Survival curve was drawn by Kaplan-Meier method,and survival difference was tested by Log-rank.Multivariate Cox proportional risk model was used to analyze the factors affecting overall survival(OS)and relapse-free survival(RFS)in patients with gastric cancer.Results The median OS and RFS of LAGC patients were 22.1 months and 14.9 months.There were 78 recurrences and 64 deaths.Clinical stage and systemic inflammatory markers,including SII,SIRI,PIV,PLR,and NLR,were significantly lower in patients who did not relapse or survived compared with patients who relapsed or died.PNI was significantly higher(P＜0.05).According to ROC curve,the cut-off values of SII,SIRI,PLR and NLR for predicting LAGC recurrence were 350.580,1.738,112.125 and 3.018,and the cut-off values for predicting death were 355.758,1.076,149.125 and 2.505.In addition,the cut-off values of PNI and PIV for predicting recurrence and death were both 51.255 and 170.781.Multivariate Cox regression analysis showed that clinical stage,PNI and NLR were independent influencing factors for recurrence and death in LAGC patients(P＜0.05).RFS and OS were longer in patients with PNI ≥51.255(P＜0.05).Patients with NLR≥3.018 had shorter RFS and patients with NLR≥2.505 had shorter OS(P＜0.05).Conclusion PNI and postoperative systemic inflammatory markers(especially NLR)are independent prognostic factors for D2 radical resection and adjuvant concurrent chemoradiothergpy in LAGC patients.