Combined inflammation/nutrition-based prognostic score for overall survival in gastric adenocarcinoma: A retrospective cohort study

doi:10.4240/wjgs.121272

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World Journal of Gastrointestinal Surgery

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1948-9366

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

Retrospective Cohort Study

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 Surg. Aug 27, 2026; 18(8): 121272
Published online Aug 27, 2026. doi: 10.4240/wjgs.121272

Combined inflammation/nutrition-based prognostic score for overall survival in gastric adenocarcinoma: A retrospective cohort study

Mehmet Hanifi Çanakcı, Ilgaz Kayılıoğlu, Ahmet Şimşek, Tolga Dinç

Mehmet Hanifi Çanakcı, Department of General Surgery, Etlik City Hospital, Ankara 06170, Türkiye

Ilgaz Kayılıoğlu, Department of General Surgery, Private Yücelen Hospital, Muğla 48050, Türkiye

Ahmet Şimşek, Department of General Surgery, Buca Seyfi Demirsoy Hospital, İzmir 35390, Türkiye

Tolga Dinç, Department of General Surgery, University of Health Sciences, Ankara 06800, Türkiye

Author contributions: Çanakcı MH and Kayılıoğlu I performed data analysis, revised and drafted the manuscript; Çanakcı MH and Dinç T conceived and designed the study; Çanakcı MH, Şimşek A, and Dinç T contributed to data acquisition and assisted in manuscript revision; all authors contributed to the interpretation of data and approved the final version of the manuscript.

AI contribution statement: ChatGPT was used in manuscript only for language polishing, typo and grammar checking purposes. On the other hand, the answer letter to the reviewer comments were translated by ChatGPT. Other than these 2 instances, no ai tool was used for data analysis, interpretation, literature review or making adjustments regarding reviewer’s comments. All the images were generated by the corresponding author, using Google Colab, GIMP and Microsoft Powerpoint software tools, not by an AI.

Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Ankara City Hospital (approval E1/3303/2023). Prior to hospital admission, all patients signed a written informed consent form issued by the institution, allowing the use of anonymized medical data for research purposes.

Informed consent statement: Since only anonymized data were analyzed, the requirement for additional individual consent was waived by the committee. Patients who declined to provide this institutional consent were not included in the study.

Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.

STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.

Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Corresponding author: Ilgaz Kayılıoğlu, MD, Associate Professor, Department of General Surgery, Private Yücelen Hospital, 65 Sk 22/C, Kötekli, Menteşe, Muğla 48050, Türkiye. kayilioglu@yahoo.com

Received: March 25, 2026
Revised: April 17, 2026
Accepted: May 29, 2026
Published online: August 27, 2026
Processing time: 145 Days and 17.2 Hours

Abstract

BACKGROUND

Gastric cancer is the fifth most common malignancy and the fourth leading cause of cancer-related death. The tumor-node-metastasis (TNM) staging system, while fundamental, does not account for systemic inflammation and nutritional status, which impact survival.

AIM

To assess the prognostic value of a novel inflammation/nutrition-based combined score (INCS) for predicting overall survival in patients undergoing curative gastrectomy for gastric adenocarcinoma.

METHODS

This retrospective cohort study included 154 consecutive patients (2019-2022). INCS integrated neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, prognostic nutritional index, and prognostic index, categorized as low (0-3) or high (4-6). Overall survival was analyzed using Kaplan-Meier, log-rank, and multivariable Cox regression.

RESULTS

Median age was 68 years (interquartile range: 61-76), 62.3% were male. During follow up (median 25.1 months), 61.0% died. High INCS was associated with higher mortality (87.9% vs 53.7%, P < 0.001) and advanced TNM stage (P < 0.001). In multivariable analysis without TNM stage, INCS independently predicted mortality (hazard ratio = 1.20, 95%CI: 1.04-1.39, P = 0.013). The TNM + INCS model showed a higher area under the curve than TNM alone (0.805 vs 0.787), with no statistically significant difference.

CONCLUSION

INCS is a simple, and potentially useful prognostic tool for gastric cancer patients undergoing curative gastrectomy. Combined with TNM staging, it may enhance risk stratification and guide postoperative management.

Keywords: Adenocarcinoma; Inflammation; Nutritional status; Prognosis; Stomach neoplasms; Survival analysis

Core Tip: This retrospective cohort study found that the inflammation/nutrition-based combined score was associated with overall survival in patients undergoing curative gastrectomy for gastric adenocarcinoma. When added to tumor-node-metastasis staging, inflammation/nutrition-based combined score may improve prognostic accuracy. The score reflects systemic inflammation and nutritional status, offering complementary information to tumor anatomy. While these findings are promising, they require validation in larger, multicenter studies before clinical application.