Abstract
BACKGROUND: Metabolism plays an important role in the occurrence and development of gastric cancer, including in neoadjuvant immunochemotherapy. However, whether nutrition-related indicators can predict the efficacy of neoadjuvant immunochemotherapy and the prognosis of gastric cancer patients has not been addressed. This study systematically screens various nutritional indicators to explore their efficacy in predicting responses to neoadjuvant immunochemotherapy and patients' prognosis in locally advanced gastric cancer (LAGC). METHODS: We retrospectively analyzed 134 LAGC patients who underwent radical resection after neoadjuvant immunochemotherapy. According to postoperative tumor regression grade (TRG), these patients were divided into good responder group (TRG1-0) and poor responder group (TRG3-2) (AJCC/CAP guidelines). Inflammatory and/or nutritional markers were compared for their efficacy on predicting patients' pathological tumor regression response. The univariate and multivariate logistic regression were carried out to identify the independent factors for predicting pathological tumor regression response, and a predictive nomogram model was further established. RESULTS: Among the total 134 LAGC patients, tumor specimens from 71 and 63 patients had TRG1-0 and TRG3-2 tumor responses, respectively. Multivariate analysis showed that controlling nutritional status (CONUT) score and nutrition risk screening 2002 (NRS2002) score were independent predictors of pathological tumor regression response (OR, 0.68; 95% CI, 0.50-0.91; P = 0.010 and OR, 0.66; 95% CI, 0.45-0.96; P = 0.031, respectively). With the use of ROC curve analysis, the optimal critical level of CONUT score and NRS2002 score were both 3. The CONUT-NRS2002 combined score was constructed. Patients with lower CONUT-NRS2002 had a better pathological response than those with higher CONUT-NRS2002 (P = 0.003). Moreover, Patients with higher CONUT-NRS2002 scores had poorer prognosis (P < 0.05). The nomogram based on CONUT score and NRS2002 score demonstrated good predictive ability and clinical application value. CONCLUSIONS: CONUT score and NRS2002 score are independent factors of pathological tumor regression response in LAGC patients after neoadjuvant immunochemotherapy. The constructed CONUT-NRS2002 combined score has a good potential in predicting pathological tumor regression response and prognosis of LAGC patients after neoadjuvant immunochemotherapy, serving as a new predictive indicator.