Liu ZhanShuo, Liu Hao, Zhang Yue, Yang YuHang, Gao Hongyu
Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China.
Department of Urology, The Third Affillated Hospital of Qiqihaer Medical University, Qiqihar Medical University, Qiqihar, People's Republic of China.
J Inflamm Res. 2025 Aug 29;18:11869-11882. doi: 10.2147/JIR.S523882. eCollection 2025.
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.
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.
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).
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.
胃癌（GC）的病理肿瘤-淋巴结-转移（pTNM）分期系统的预后判别能力仍需进一步提高。本研究旨在通过将pTNM分期与外周炎症状态相结合，开发一种pTNM-炎症（pTNM-I）分期系统，以增强pTNM的预后分层能力。
本研究回顾性分析了4049例行GC根治性手术的患者。采用受试者工作特征（ROC）分析确定不同pTNM分期的中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和全身免疫炎症指数（SII）的最佳截断值，并构建pTNM-I分期系统。采用Kaplan-Meier生存曲线评估pTNM-I对预后的影响。采用Cox回归分析确定影响患者预后的独立危险因素。最后，基于pTNM-I分期和临床病理特征构建列线图。
根据NLR、PLR和SII的最佳截断值构建pTNM-I分期系统后，I-a期至III-c期的5年生存率分别为97.6%、88.0%、84.2%、92.5%、77.5%、71.3%、74.3%、45.3%和27.5%（P<0.001）。ROC分析显示，pTNM-I的预测能力优于pTNM（AUC：0.798对0.743）。Cox分析显示，pTNM-I是与患者预后相关的独立预后因素（P<0.001）。与传统pTNM分期相比，基于pTNM-I的列线图也显示出更好的预测性能（AUC：0.808对0.743）。
pTNM-I分期系统具有更强的预后判别能力。作为一种简单经济的常规预后工具，值得临床应用。
