Preoperative cancer-inflammation-prognostic-index-based nomogram for overall survival in stage I-III gastric cancer

doi:10.4251/wjgo.124250

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. Dec 15, 2026; 18(12): 124250
Published online Dec 15, 2026. doi: 10.4251/wjgo.124250

Preoperative cancer-inflammation-prognostic-index-based nomogram for overall survival in stage I-III gastric cancer

Ning Chang, Li-Xiang Zhang, En-Ze Zhou, Zhi-Jian Wei, A-Man Xu

Ning Chang, Zhi-Jian Wei, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230031, Anhui Province, China

Li-Xiang Zhang, Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Hefei 230031, Anhui Province, China

En-Ze Zhou, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China

A-Man Xu, Department of Gastrointestinal and Hernia Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China

Co-first authors: Ning Chang and Li-Xiang Zhang.

Co-corresponding authors: Zhi-Jian Wei and A-Man Xu.

Author contributions: Chang N and Zhang LX conceptualized and designed the study, drafted the initial manuscript and collected and analysed the data, they contributed equally to this article, they are the co-first authors of this manuscript; Zhou EZ provided software support and prepared the figures and tables; Wei ZJ and Xu AM reviewed and revised the manuscript they contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors read and approved the final manuscript.

AI contribution statement: During the preparation of this manuscript, the authors used ChatGPT (OpenAI) solely to improve language clarity and readability. The authors subsequently reviewed and edited all AI-assisted content and take full responsibility for the final manuscript.

Institutional review board statement: This study was approved by the Medical Ethics Committee of The First Affiliated Hospital of Anhui Medical University, approval No. PJ 2025-01-61.

Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that was obtained after each patient agreed to treatment by written consent.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The anonymized data and statistical code supporting the findings of this study are available from the corresponding author upon reasonable request.

Corresponding author: Zhi-Jian Wei, Professor, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230031, Anhui Province, China. yfy1041018@fy.ahmu.edu.cn

Received: June 10, 2026
Revised: July 30, 2026
Accepted: September 15, 2026
Published online: December 15, 2026
Processing time: 153 Days and 2.7 Hours

Abstract

BACKGROUND

Gastric cancer (GC) remains a leading cause of cancer-related morbidity and mortality worldwide. Survival after radical gastrectomy varies substantially, even among patients with the same tumour-node-metastasis stage. Simple, reliable, and readily available prognostic markers are therefore needed to improve postoperative risk stratification. This study evaluated the prognostic value of the preoperative Cancer Inflammation Prognostic Index (CIPI), an easily measurable marker integrating carcinoembryonic antigen and neutrophil-to-lymphocyte ratio, in patients with stage I-III GC after radical gastrectomy.

AIM

To evaluate preoperative CIPI and develop a CIPI-based survival nomogram after radical gastrectomy for stage I-III GC.

METHODS

This retrospective study included 1071 patients with stage I-III GC who underwent radical gastrectomy between 2014 and 2017. Patients were divided into training (n = 748) and internal validation (n = 323) cohorts. The CIPI cutoff was derived using time-dependent receiver operating characteristic analysis in the training cohort and applied unchanged to the internal validation cohort. Overall survival (OS) was evaluated using Kaplan-Meier and Cox analyses. A nomogram incorporating age, tumour size, T stage, N stage, CIPI, and carbohydrate antigen 19-9 was developed for OS prediction.

RESULTS

Using a CIPI cutoff of 8.59, 701 patients were classified as low CIPI and 370 as high CIPI. High CIPI was associated with adverse clinicopathological features and poorer OS in the overall cohort (P < 0.0001), stage I/II subgroup (P = 0.011), and stage III subgroup (P < 0.0001). It remained independently associated with worse OS [hazard ratio = 1.61, 95% confidence interval (CI): 1.22-2.12; P < 0.001]. The nomogram yielded C-indices of 0.759 (95%CI: 0.733-0.790) versus 0.704 (95%CI: 0.673-0.732) in the training cohort and 0.742 (95%CI: 0.696-0.786) versus 0.708 (95%CI: 0.665-0.753) in the internal validation cohort. Calibration was acceptable, and decision curve analysis indicated potential net benefit across exploratory threshold ranges.

CONCLUSION

Preoperative CIPI is an independent prognostic factor for OS in patients with stage I–III GC after radical gastrectomy. The CIPI-based nomogram showed modestly improved prognostic performance and may serve as a supplementary prognostic marker.

Keywords: Gastric cancer; Cancer inflammation prognostic index; Overall survival; Nomogram; Prognosis; Systemic inflammation

Core Tip: The Cancer Inflammation Prognostic Index (CIPI), calculated as carcinoembryonic antigen multiplied by the neutrophil-to-lymphocyte ratio, integrates tumour burden with systemic inflammation. In this retrospective cohort of 1071 patients with stage I-III gastric cancer undergoing radical gastrectomy, a high preoperative CIPI was independently associated with poorer overall survival and further stratified risk within tumour-node-metastasis stages. A CIPI-based nomogram showed modestly better discrimination than a reference T-N model and acceptable calibration on internal validation. CIPI may complement conventional staging, but external validation and prospective assessment are required before clinical implementation.