Du Yongtao, Li Yunlong, Tan Zhaobang, Song Jiawei, Jiang Yu, Liu Shuai, Guo Yajie, Qiao Yihuan, Zhu Jun, Li Shisen, Li Jipeng
Department of Digestive Surgery, The First Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, China.
School of Clinical Medicine, Xi'an Medical University, Xi'an, Shaanxi, China.
Front Nutr. 2025 Jun 10;12:1562202. doi: 10.3389/fnut.2025.1562202. eCollection 2025.
Gastric cancer (GC) patients frequently face the debilitating comorbidity of malignant cachexia, a condition that consistently forecasts a dismal prognosis. Early diagnosis of cachexia and timely prediction of survival outcomes are essential for them. Here, we aimed to construct an immune-inflammatory-nutritional-tumor-marker (IINTM) prognostic score for GC, and further scrutinize its clinical relevance in early forecasting the cachexia.
A total of 1,101 GC patients underwent curative surgical were incorporated in our study, and they were evaluated by the Computed Tomography (CT) of skeletal muscle mass at third lumbar spine plane levels (SMI-L3). Using restricted cubic spline (RCS) analysis, we examined associations between prognosis and nutritional indices, including the Prognostic Nutritional Index (PNI) and Systemic Immune-Inflammation Index (SII). The IINTM score was constructed by the multivariate Cox analysis and evaluated by the Receiver Operating Characteristic (ROC) and area under the ROC (AUC).
We identified striking discrepancies in immunonutrition profiles and prognoses between cachexia and non-cachexia GC patients. Patients with cachexia had worse prognosis and lower SMI-L3 scores than those without cachexia. The IINTM score, incorporating PNI, SII, body mass index (BMI), NRS2002, serum albumin, platelet, D-dimer, CEA, and CA199, exhibited a high concordance index (C-index) of 0.784, underscoring its robust predictive efficacy. Most crucially, IINTM score demonstrated substantial diagnostic value for cachexia, with an AUC of 0.858, denoting its high degree of accuracy.
The IINTM score could be a reliable tool and precisely predict the cachexia and prognosis for GC patients. Our findings provide novel insights into the role of immune-inflammatory-nutrition, tumor marker and cachexia in GC patients.
胃癌（GC）患者经常面临恶性恶病质这种使人衰弱的合并症，这种情况一直预示着预后不佳。对恶病质进行早期诊断并及时预测生存结果对他们至关重要。在此，我们旨在构建一种用于GC的免疫 - 炎症 - 营养 - 肿瘤标志物（IINTM）预后评分，并进一步审视其在早期预测恶病质方面的临床相关性。
共有1101例行根治性手术的GC患者纳入我们的研究，并通过第三腰椎平面水平的骨骼肌质量计算机断层扫描（CT）（SMI - L3）对他们进行评估。使用受限立方样条（RCS）分析，我们研究了预后与营养指标之间的关联，包括预后营养指数（PNI）和全身免疫炎症指数（SII）。IINTM评分通过多变量Cox分析构建，并通过受试者工作特征（ROC）和ROC曲线下面积（AUC）进行评估。
我们发现恶病质和非恶病质GC患者在免疫营养特征和预后方面存在显著差异。恶病质患者的预后比无恶病质患者更差，且SMI - L3评分更低。纳入PNI、SII、体重指数（BMI）、NRS2002、血清白蛋白、血小板、D - 二聚体、癌胚抗原（CEA）和糖类抗原199（CA199）的IINTM评分表现出0.784的高一致性指数（C指数），突出了其强大的预测效能。最关键的是，IINTM评分对恶病质显示出显著的诊断价值，AUC为0.858，表明其具有高度准确性。
IINTM评分可能是一种可靠的工具，能够准确预测GC患者的恶病质和预后。我们的研究结果为免疫 - 炎症 - 营养、肿瘤标志物和恶病质在GC患者中的作用提供了新的见解。
