Abstract
OBJECTIVES: Albumin-globulin ratio (AGR), prognostic nutritional index (PNI), and platelet-to-lymphocyte ratio (PLR) have been validated as prognostic factors for gastric cancer (GC). However, significant gender differences exist in albumin levels and inflammatory cell counts, and further research is required to understand how these differences influence GC prognosis. This study aims to investigate the prognostic impact of nutritional and inflammatory indicators on GC patients undergoing radical surgery, as well as the influence of gender on these indicators' prognostic value. METHODS: The study included 596 patients with advanced GC hospitalized in the Department of Gastrointestinal Surgery, General Surgery, Xiangya Hospital of Central South University from January 2012 to December 2016. Receiver operating characteristic (ROC) analysis was performed to determine cutoff values for nutritional and inflammatory factors. Univariate analysis was used to identify factors significantly affecting survival in GC patients, while multivariate and Kaplan-Meier analyses determined independent prognostic factors for GC. RESULTS: Multivariate analysis revealed that postsurgical tumor node metastasis (pTNM) stage [stage II: hazard ratio (HR)=3.284, P=0.012; stage III: HR: 8.062, P<0.001], low preoperative AGR (HR=1.499, P=0.012), and postoperative PNI (HR=1.503, P=0.008) were risk factors for overall survival in male patients after radical GC surgery. For female patients, pN2-3 (HR=3.185, P<0.001), total gastrectomy (HR=2.286, P=0.004), low preoperative PLR (HR=1.702, P=0.027), and postoperative PNI (HR=1.943, P=0.011) were identified as risk factors for overall survival. CONCLUSIONS: Postoperative PNI is an independent risk factor for all advanced GC patients. Preoperative PLR is an independent prognostic factor only for female patients, while preoperative AGR is an independent prognostic factor only for male patients. Further research is warranted to investigate the gender-specific differences in GC prognosis.