Effect of perioperative nutritional status, inflammatory response and postoperative chemotherapy on survival after gastrectomy for advanced gastric cancer.

Authors

Yoshinori Fujiwara, Shunji Endo, Masaharu Higashida, Masaaki Hori, Yoko Endo, Ryoko Makieda, Akihide Fujii, Miyoko Kobayashi, Kazuhiko Yoshimatsu, Tomio Ueno

Published in

Oncology letters. Volume 32. Issue 4. Pages 468. Epub Aug 18, 2026.

Abstract

Despite the availability of numerous perioperative prognostic indicators for advanced gastric cancer, their relative predictive accuracy has not been compared. The present study investigated the association of these indicators and postoperative chemotherapy with patient survival in advanced gastric cancer. A total of 142 patients with stage II-IV gastric cancer who underwent gastrectomy with R0/R1 resection were examined. The preoperative modified Glasgow prognostic score (mGPS), controlling nutritional status score, CRP-to-albumin ratio, prognostic nutritional index and neutrophil-to-lymphocyte ratio was calculated. Postoperative serum CRP was evaluated as the CRPmax. Postoperative chemotherapy was administered according to the Japanese Gastric Cancer Treatment Guidelines. Patients were divided into chemotherapy and no chemotherapy groups, followed by propensity score matching to adjust for background factors. The endpoints were relapse-free survival (RFS) and overall survival (OS). Prognostic factors were evaluated using the Cox proportional hazard model. The OS and RFS were found to be improved in the chemotherapy group compared with the no chemotherapy group (P<0.05) and in the low mGPS group compared with the high mGPS group (P<0.05). Stepwise regression analysis identified the mGPS as the most reliable preoperative marker for both OS and RFS. Cox analysis of the matched groups revealed that postoperative chemotherapy was an independent prognostic factor for RFS and that mGPS was an independent prognostic factor for OS. A preoperative CRP of <0.3 mg/dl and a low mGPS score were found to be independent prognostic factors for RFS in the chemotherapy group. Overall, postoperative chemotherapy was found to reduce recurrence in advanced gastric cancer, while the preoperative mGPS was a strong prognostic marker for OS. Improving the preoperative mGPS may therefore improve both OS and the effectiveness of postoperative chemotherapy, but future large-scale studies are needed.

PMID:
42644014
Bibliographic data and abstract were imported from PubMed on 26 Aug 2026.

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