A Novel Inflammatory-Nutritional Prognostic Scoring System for Stage III Gastric Cancer Patients With Radical Gastrectomy Followed by Adjuvant Chemotherapy

Abstract

PurposeThe present study was designed to explore the prognostic value of preoperative inflammatory and nutritional biomarkers in stage III gastric cancer (GC) patients with adjuvant chemotherapy and to develop a novel scoring system called the inflammatory-nutritional prognostic score (INPS).MethodsA total of 513 patients with pathological stage III GC undergoing radical gastrectomy followed by adjuvant chemotherapy from 2010 to 2017 were enrolled in the study. Clinicopathological characteristics and blood test parameters of individual patients were collected. The least absolute shrinkage and selection operator (LASSO) Cox regression model was used for feature selection to construct INPS. Survival curves were generated using the Kaplan-Meier method with log-rank tests. The nomogram was generated based on the result of the multivariate analysis using Cox’s proportional hazards model. The model was assessed by the concordance index (C-index) and was internally validated by bootstraps.ResultsAccording to the results of Lasso Cox regression and K-M survival curves, INPS was determined as follows: a low body mass index (BMI) (<23 kg/m2), a low prealbumin (<180 mg/L), a high neutrophil-lymphocyte ratio (NLR) (≥2.7), a high platelet-lymphocyte ratio (PLR) (≥209.4), a low lymphocyte-monocyte ratio (LMR) (<2.8), and a low prognostic nutritional index (PNI) (<45.1); each were scored as 1, and the remaining values were scored as 0. The individual scores were then summed up to construct the INPS and further divided into 4 groups: Low Risk (INPS 0); Low-medium Risk (INPS 1); High-medium Risk (INPS 2-4); and High Risk (INPS 5-6). In multivariate analysis, INPS was an independent predictor of overall survival (OS) in stage III GC, with the 5-year OS rates of 70.8%, 57.4%, 41.5%, and 30.6%, respectively. The nomogram based on INPS and other independent predictors (gender, pT stage, pN stage, lymphovascular invasion, and CEA level) showed good predicting performance with a C-index of 0.707, which was superior to the TNM stage alone (C-index 0.645, p=0.008) and was internally validated with the corrected C-index of 0.693.ConclusionPreoperative INPS was an independent prognostic factor of stage III GC patients with radical surgery followed by adjuvant chemotherapy. The nomogram based on INPS may serve as a simple and potential model in risk stratification and guiding treatment strategies in clinical practice.

Peripheral Lymphocyte Subsets Absolute Counts as Feasible Clinical Markers for Predicting Surgical Outcome in Gastric Cancer Patients After Laparoscopic D2 Gastrectomy: A Prospective Cohort Study

“…The authors proved that INPS score has a good predicting performance for overall survival in stage III gastric cancer patients with radical surgery followed by adjuvant chemotherapy. 45 In our study, our results also showed that NLR was significantly associated with prolonged hospital stay and complication in univariate analysis. However, this association did not reach statistical significance in multivariate analysis.…”

A Novel Inflammatory-Nutritional Prognostic Scoring System for Patients with Early-Stage Breast Cancer

“…Integration of multiple biomarkers could provide prognostic models with substantially higher predictive accuracy than that achieved with models based on one or a few inflammatory biomarkers. 12 , 21 , 37 But most of current studies simply combined candidate inflammatory parameters with strong collinearity and correlation into a multivariate Cox regression model to identify independent predictors, which can lead to conflict between parameters and certain statistical problems. 12 In this study, we performed the LASSO Cox regression analysis to include the maximal number of available inflammatory-nutritional biomarkers and effectively single out four valuable inflammatory indexes, namely, NLR, MLR, PNI, and AAPR; this approach could avoid the influence of multicollinearity to some extent.…”

Clinical Significance of the Prealbumin Level in Gastric Cancer Patients Who Receive Curative Treatment

“…Recently, the preoperative nutritional status was shown to affect the occurrence of postoperative surgical complications, toxicity of adjuvant treatment, and patient's survival in various malignancies [7][8][9][10]. Although several scoring system and serum biomarker have been tested, optimal nutritional biomarkers have not yet been established.…”