Abstract
BACKGROUND: Metabolism and nutrition status play an important role in the development of cancer. However, whether inflammation and malnutrition related indicators can predict the efficacy of neoadjuvant chemotherapy (NACT) and the prognosis of gastric cancer has not been addressed. AIM: To evaluate the predictive value of malnutrition as determined by the geriatric nutritional risk index (GNRI) and inflammation represented by the pan-immune-inflammation value (PIV) for the response to NACT patients' prognosis in locally advanced gastric cancer (LAGC). METHODS: We retrospectively analyzed 147 LAGC patients who underwent radical resection after NACT. The PIV, and GNRI were compared according to whether receiving nutritional intervention during NACT. The prognostic values of GNRI and PIV were assessed using time-dependent receiver operating characteristic curve analysis, log-rank tests, and Cox regression analysis. RESULTS: Nutritional intervention could improve nutrition status and reduce inflammation during NACT in LAGC patients. Multivariate analysis showed that GNRI (hazard ratio = 0.956, 95% confidence interval: 0.923-0.991, P = 0.013), PIV (hazard ratio = 1.002, 95% confidence interval: 1-1.005, P = 0.041) were independent predictors for OS. Significant differences of overall survival and disease-free survival according to GNRI (P < 0.001) and PIV (P < 0.001) were observed between the low and high groups. The GNRI-PIV score constructed with GNRI and PIV had a higher area under the curve and was significantly associated with pathological tumor regression response. CONCLUSION: GNRI and PIV are useful predictive biomarkers in patients with LAGC receiving NACT, and nutritional supplement can improve patients' status. The GNRI-PIV score may contribute to a more personalized and holistic approach for LAGC patients underwent NACT.