Zhang Ling-Kang, Zheng Hua-Long, Zheng Xiao-Yun, Xu Bin-Bin, Tang Yi-Hui, Zheng Zhi-Wei, Zheng Hong-Hong, Lin Guang-Tan, Li Ping, Zheng Chao-Hui, Huang Chang-Ming, Xie Jian-Wei
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
Int J Surg. 2025 Jun 12;111(9):5868-81. doi: 10.1097/JS9.0000000000002707.
Although the cachexia index(CXI) is a well established prognostic predictor in gastric cancer(GC) patients, its effectiveness in patients with locally advanced gastric cancer(LAGC) who have undergone neoadjuvant chemotherapy(NACT) remains unclear.
This multicenter study included 600 LAGC patients treated with NACT from January 2010 to June 2022. A modified CXI was constructed based on Random Forest model, calculated as (post-NACT subcutaneous adipose tissue area at L3) ×(post-NACT serum albumin)/(post-NACT platelet count). Patients were categorized into mCXI-low and mCXI-high.
In the training cohort, mCXI outperformed the traditional CXI in predicting of overall survival(OS) and tumor regression grades. The mCXI-high group had a significantly higher 3-year OS(73.0% vs. 58.9%,P = 0.002), recurrence-free survival(67.7% vs. 50.2%,P = 0.002), and disease-specific survival(74.4% vs. 62.5%,P = 0.012). Multivariate analysis comfirmed that mCXI as an independent prognostic factor. The recurrence rate was significantly lower in the mCXI-high group(33.0% vs. 52.6%; P<0.001). The mCXI-high group also had a lower recurrence rate (33.0% vs. 52.6%, P < 0.001) and a delayed recurrence peak (33.51 vs. 7.11 months). Similar results were obtained in the validation cohort. Further analysis showed that in mCXI-low patients with ypStage III disease, receiving more than 4 cycles of adjuvant chemotherapy (AC) significantly improved survival (3-year OS: 43.7% vs. 25.0%, P = 0.007). In mCXI-high patients, 4-6 AC cycles yielded optimal outcomes.
mCXI was associated with the overall prognosis in patients with LAGC underwent NACT, is superior to traditional CXI, and may serve as a decision-making tool for guiding personalized postoperative AC.
尽管恶病质指数（CXI）是胃癌（GC）患者中一种成熟的预后预测指标，但其在接受新辅助化疗（NACT）的局部晚期胃癌（LAGC）患者中的有效性仍不明确。
这项多中心研究纳入了2010年1月至2022年6月期间接受NACT治疗的600例LAGC患者。基于随机森林模型构建了改良的CXI，计算方法为（NACT后L3水平的皮下脂肪组织面积）×（NACT后血清白蛋白）/（NACT后血小板计数）。患者被分为低mCXI组和高mCXI组。
在训练队列中，mCXI在预测总生存期（OS）和肿瘤退缩分级方面优于传统CXI。高mCXI组的3年总生存期显著更高（73.0%对58.9%，P = 0.002），无复发生存期（67.7%对50.2%，P = 0.002），以及疾病特异性生存期（74.4%对62.5%，P = 0.012）。多因素分析证实mCXI是一个独立的预后因素。高mCXI组的复发率显著更低（33.0%对52.6%；P<0.001）。高mCXI组的复发率也更低（33.0%对52.6%，P < 0.001）且复发高峰延迟（33.51对7.11个月）。在验证队列中也获得了类似结果。进一步分析表明，在ypStage III期疾病的低mCXI患者中，接受超过4周期的辅助化疗（AC）显著改善了生存期（3年总生存期：43.7%对25.0%，P = 0.007）。在高mCXI患者中，4 - 6周期的AC产生了最佳结果。
mCXI与接受NACT的LAGC患者的总体预后相关，优于传统CXI，并且可作为指导个体化术后AC的决策工具。
