Prognostic Enhancement in Gastric Cancer Through the Integration of Inflammatory Indices into the pTNM-Inflammation Staging System (pTNM-I).

BACKGROUND

The prognostic discriminative ability of the pathological tumor-node-metastasis (pTNM) staging system for gastric cancer (GC) still requires further improvement. This study aimed to develop a pTNM-Inflammation (pTNM-I) staging system by integrating pTNM staging with peripheral inflammatory status to enhance the prognostic stratification capability of pTNM.

METHODS

This study retrospectively analyzed 4,049 patients who underwent curative surgery for GC. Receiver Operating Characteristic (ROC) analysis was used to determine the optimal cutoff values of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) for different pTNM stages, and the pTNM-I staging system was constructed. Kaplan-Meier survival curves were used to evaluate the impact of pTNM-I on prognosis. Cox regression analysis was employed to identify independent risk factors affecting patient outcomes. Finally, a nomogram was constructed based on pTNM-I staging and clinical pathological characteristics.

RESULTS

After constructing the pTNM-I staging system based on the optimal cutoff values of NLR, PLR, and SII, the 5-year survival rates for stages I-a to III-c were 97.6%, 88.0%, 84.2%, 92.5%, 77.5%, 71.3%, 74.3%, 45.3%, and 27.5% (P < 0.001). ROC analysis showed that the predictive ability of pTNM-I was superior to that of pTNM (AUC: 0.798 vs 0.743). Cox analysis revealed that pTNM-I was an independent prognostic factor associated with patient outcomes (P < 0.001). The nomogram based on pTNM-I also demonstrated better predictive performance compared to the traditional pTNM staging (AUC: 0.808 vs 0.743).

CONCLUSION

The pTNM-I staging system provided more robust prognostic discriminative ability. As a simple, economical, and routine prognostic tool, it is worthy of clinical application.