Background:The aim of this study was to evaluate different preoperative immune, inflammatory, and nutritional scores and their best cut-off values as predictors of poorer overall survival (OS) and disease-free survival (DFS) in patients who underwent curative gastric cancer resection.Methods:This was a retrospective observational multicentre study based on data of the Spanish EURECCA Esophagogastric Cancer Registry. Time-dependent Youden index and log-rank test were used to obtain the best cut-offs of 18 preoperative biomarkers for OS and DFS. An adjusted Cox model with variables selected by bootstrapping was used to identify the best preoperative biomarkers, which were also analysed for every TNM stage.Results:High neutrophil-to-lymphocyte ratio (NLR), high monocyte systemic inflammation index (moSII), and low prognostic nutritional index (PNI) were identified as independent predictors of poor outcome: NLR > 5.91 (HR:1.73; 95%CI [1.23–2.43]), moSII >2027.12 (HR:2.26; 95%CI [1.36–3.78]), and PNI >40.31 (HR:0.75; 95%CI [0.58–0.96]) for 5-year OS and NLR > 6.81 (HR:1.75; 95%CI [1.24–2.45]), moSII > 2027.12 (HR:2.46; 95%CI [1.49–4.04]), and PNI > 40.31 (HR:0.77; 95%CI [0.60,0.97]) for 5-year DFS. These outcomes were maintained in the whole cohort for NLR and moSII (p< 0.05) but not in stage II and for PNI in all tumoral stages. The associations of NLR-PNI and moSII-PNI were also a relevant prognostic factor for OS.Conclusions:High NLR, high moSII (for stages I and III), and low PNI (regardless of tumour stage) were the most promising preoperative biomarkers to predict poor OS and DFS in gastric cancer patients treated with curative intent.
背景：本研究旨在评估不同术前免疫、炎症及营养评分及其最佳截断值，作为预测接受根治性胃癌切除术患者较差总生存期（OS）和无病生存期（DFS）的指标。方法：本研究为一项基于西班牙EURECCA食管胃癌登记处数据的回顾性观察性多中心研究。采用时间依赖性约登指数和对数秩检验，确定18项术前生物标志物对OS和DFS的最佳截断值。通过自助法筛选变量并构建校正Cox模型，以识别最佳术前生物标志物，并针对各TNM分期进行分析。结果：高中性粒细胞-淋巴细胞比值（NLR）、高单核细胞系统炎症指数（moSII）及低预后营养指数（PNI）被确定为不良预后的独立预测因子：NLR > 5.91（风险比：1.73；95%置信区间[1.23–2.43]）、moSII > 2027.12（风险比：2.26；95%置信区间[1.36–3.78]）和PNI > 40.31（风险比：0.75；95%置信区间[0.58–0.96]）与5年OS相关；NLR > 6.81（风险比：1.75；95%置信区间[1.24–2.45]）、moSII > 2027.12（风险比：2.46；95%置信区间[1.49–4.04]）和PNI > 40.31（风险比：0.77；95%置信区间[0.60,0.97]）与5年DFS相关。在整个队列中，NLR和moSII的预测效果持续显著（p<0.05），但在II期患者中未体现；而PNI在所有肿瘤分期中均保持预测价值。NLR-PNI与moSII-PNI联合指标也是OS的重要预后因素。结论：高NLR、高moSII（适用于I期和III期）及低PNI（与肿瘤分期无关）是预测接受根治性治疗的胃癌患者不良OS和DFS最具潜力的术前生物标志物。
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