Zheng Hualong, Zheng Honghong, Du Xiaoqiang, Xu Binbin, Hu Minggao, Yu Junhua, Xie Rongzhen, Wei Linghua, Xue Zhen, Shen Lili, Lin Jia, Xie Jianwei, Zheng Chaohui, Huang Changming, Li Ping
Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, FuzhouFujian Province, 350000, China.
Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China.
Surg Endosc. 2025 Apr;39(4):2609-2624. doi: 10.1007/s00464-025-11596-6. Epub 2025 Mar 6.
Oxidative stress, immune response, and inflammation play an important role in the occurrence and progression of gastric cancer (GC). This study is to develop a novel prognostic oxidative stress-immune-inflammation score (POSII score) and to explore the clinical value of the novel nomograms incorporating this factor in survival and recurrence risk.
This study included 3612 GC patients who underwent radical gastrectomy at three tertiary hospitals from 2009 to 2020. One hospital formed the training and internal validation cohorts, while the other two constituted the external validation cohort. Twelve hematological markers were collected and analyzed to develop the POSII score via LASSO regression. Two online calculators were developed and validated.
The POSII score categorized patients into low and high POSII groups, with the low POSII group showing significantly improved 5-year overall survival (OS) and disease-free survival (DFS) rates, as well as a markedly reduced risk of recurrence (all P < 0.05). Multivariate COX regression showed that the POSII score was an independent prognostic factor. Based on the POSII score, two nomograms (OS: AUC = 0.837; DFS: AUC = 0.834, respectively) for individualized prognostic prediction were constructed. To enhance clinical usability, we further developed two user-friendly online calculators. The high-risk group had an earlier, more persistent peak of recurrence and a high incidence of multiple recurrence patterns.
Two novel online calculators based on the POSII score can be used as reliable tools for predicting survival and recurrence after radical gastrectomy. Our findings provide new insights into the role of cancer-related immune dysregulation, inflammation, and oxidative stress imbalances.
氧化应激、免疫反应和炎症在胃癌（GC）的发生和发展中起重要作用。本研究旨在开发一种新的预后氧化应激-免疫-炎症评分（POSII评分），并探讨纳入该因素的新型列线图在生存和复发风险方面的临床价值。
本研究纳入了2009年至2020年在三家三级医院接受根治性胃切除术的3612例GC患者。一家医院组成训练和内部验证队列，另外两家组成外部验证队列。收集并分析12项血液学标志物，通过LASSO回归开发POSII评分。开发并验证了两个在线计算器。
POSII评分将患者分为低POSII组和高POSII组，低POSII组的5年总生存率（OS）和无病生存率（DFS）显著提高，复发风险也显著降低（所有P<0.05）。多变量COX回归显示POSII评分是一个独立的预后因素。基于POSII评分，构建了两个用于个体化预后预测的列线图（OS：AUC=0.837；DFS：AUC=0.834）。为提高临床实用性，我们进一步开发了两个用户友好的在线计算器。高危组复发峰值出现更早、更持久，且多种复发模式的发生率较高。
基于POSII评分的两个新型在线计算器可作为预测根治性胃切除术后生存和复发的可靠工具。我们的研究结果为癌症相关免疫失调、炎症和氧化应激失衡的作用提供了新的见解。
