Immune-nutritional score-based prognostic model for predicting postoperative complications and survival in gastric cancer

doi:10.4240/wjgs.v18.i7.119514

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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 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. Jul 27, 2026; 18(7): 119514
Published online Jul 27, 2026. doi: 10.4240/wjgs.v18.i7.119514

Table 1 Mean and standard deviation of variables used for z-score standardisation in the immune-nutritional score model

Variable	mean	SD
Lymphocyte	1.39	0.30
NEU	4.40	1.44
Alb	3.94	0.48
CRP	10.10	3.12

NEU: Neutrophil-to-lymphocyte ratio; Alb: Albumin; CRP: C-reactive protein.

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Table 2 Baseline characteristics of patients with gastric cancer, n (%)/mean ± SD

Variables		Case	Non-complication group (n = 165)	Complication group (n = 82)	χ²/t/z	P value
Age	< 65 years	150	97 (58.79)	53 (64.63)	0.79	0.38
Age	≥ 65 years	97	68 (41.21)	29 (35.37)	0.79	0.38
Sex	Male	186	128 (77.58)	58 (70.73)	1.38	0.24
Sex	Female	61	37 (22.42)	24 (29.27)	1.38	0.24
BMI	> 24 kg/m²	107	79 (47.88)	28 (34.15)	4.21	0.04
BMI	≤ 24 kg/m²	140	86 (52.12)	54 (65.85)	4.21	0.04
Smoking history	Yes	106	68 (41.21)	38 (46.34)	0.59	0.44
Smoking history	No	141	97 (58.79)	44 (53.66)	0.59	0.44
Alcohol consumption history	Yes	128	84 (50.91)	44 (53.66)	0.17	0.68
Alcohol consumption history	No	119	81 (49.09)	38 (46.34)	0.17	0.68
Combined diabetes	Yes	87	53 (32.12)	34 (41.46)	2.10	0.15
Combined diabetes	No	160	112 (67.88)	48 (58.54)	2.10	0.15
Neoadjuvant chemotherapy	Yes	46	28 (16.97)	18 (21.95)	0.90	0.34
Neoadjuvant chemotherapy	No	201	137 (83.03)	64 (78.05)	0.90	0.34
Maximum tumor diameter	> 5 cm	125	77 (46.67)	48 (58.54)	3.10	0.08
Maximum tumor diameter	≤ 5 cm	122	88 (53.33)	34 (41.46)	3.10	0.08
Tumor location	Gastric body	28	20 (12.12)	8 (9.76)	0.31	0.86
	Fundus and cardia	54	36 (21.82)	18 (21.95)
	Gastric antrum	165	109 (66.06)	56 (68.29)
Histological differentiation	Poorly differentiated	132	82 (49.7)	50 (60.98)	2.81	0.25
	Moderately differentiated	71	51 (30.91)	20 (24.39)
	Well differentiated	44	32 (19.39)	12 (14.63)
TNM stage	I-II	91	65 (39.39)	26 (31.71)	1.39	0.24
TNM stage	III-IV	156	100 (60.61)	56 (68.29)	1.39	0.24
Type of gastrectomy	Partial	94	66 (40.0)	28 (34.15)	0.80	0.37
Type of gastrectomy	Complete	153	99 (60.0)	54 (65.85)	0.80	0.37
Lymph node metastasis	Yes	107	65 (39.39)	42 (51.22)	3.12	0.08
Lymph node metastasis	No	140	100 (60.61)	40 (48.78)	3.12	0.08
Perineural invasion	Yes	52	34 (20.61)	24 (29.27)	2.29	0.13
Perineural invasion	No	195	131 (79.39)	58 (70.73)	2.29	0.13
Vascular invasion	Yes	102	64 (38.79)	38 (46.34)	1.29	0.26
Vascular invasion	No	145	101 (61.21)	44 (53.66)	1.29	0.26
CEA	< 5 ng/mL	158	108 (65.45)	50 (60.98)	0.48	0.49
CEA	≥ 5 ng/mL	89	57 (34.55)	32 (39.02)	0.48	0.49
AFP	≤ 20 ng/mL	219	145 (89.51)	74 (87.06)	0.33	0.56
AFP	> 20 ng/mL	28	17 (10.49)	11 (12.94)	0.33	0.56
WBC (× 10⁹/L)		-	6.85 ± 1.66	7.21 ± 1.78	1.59	0.11
PLT (× 10⁹/L)		-	132.18 ± 9.82	133.90 ± 11.13	1.24	0.22
Lymphocyte (× 10⁹/L)		-	1.44 ± 0.29	1.27 ± 0.29	4.24	< 0.001
NEU (× 10⁹/L)		-	3.91 ± 1.14	5.39 ± 1.47	8.70	< 0.001
NLR, median (P₂₅, P₇₅)		-	2.73 (2.07, 3.45)	4.21 (3.38, 5.31)	7.77	< 0.001
Alb (g/dL)		-	4.09 ± 0.48	3.64 ± 0.32	7.61	< 0.001
CRP (mg/L)		-	8.59 ± 1.92	13.13 ± 2.88	14.70	< 0.001

BMI: Body mass index; TNM: Tumor-node-metastasis; CEA: Carcinoembryonic antigen; AFP: Alpha-fetoprotein; WBC: White blood cell count; PLT: Platelet count; NEU: Neutrophil count; NLR: Neutrophil-to-lymphocyte ratio; Alb: Albumin; CRP: C-reactive protein.

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Table 3 Multivariate analysis of risk factors for postoperative complications in patients with gastric cancer

Factor	β	SE	Wald χ² value	P value	OR	95%CI
Constant	-1.603	0.393	16.611	0	0.201	-
BMI	-0.239	0.539	0.197	0.658	0.787	0.274-2.264
Lymphocyte	-1.224	0.326	14.098	0	0.294	0.155-0.557
NEU	1.214	0.319	14.458	0	3.366	1.801-6.293
A1b	-1.39	0.341	16.584	0	0.249	0.128-0.486
CRP	3.188	0.53	36.114	0	24.238	8.569-68.557

OR: Odds ratio; CI: Confidence interval; SE: Standard error; BMI: Body mass index; NLR: Neutrophil-to-lymphocyte ratio; Alb: Albumin; CRP: C-reactive protein.

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Table 4 Diagnostic performance of immune-nutritional score based on receiver operating characteristics analysis

Variables	AUC	Sensitivity (%)	Specificity (%)	Optimal cutoff	95%CI
NEU	0.7891	67.07	83.08	> 4.85	0.7247-0.8535
Alb	0.7854	85.37	63.03	< 3.95	0.7301-0.8407
Lymphocyte	0.6457	46.34	73.94	< 1.25	0.5739-0.7174
CRP	0.9047	81.71	86.67	> 10.68	0.8618-0.9476
INS score	0.9710	93.90	90.91	> -0.7155	0.9515-0.9904

AUC: Area under the receiver operating characteristic curve; CI: Confidence interval; NEU: Neutrophil count; Alb: Serum albumin; CRP: C-reactive protein; INS: Immune-nutritional score.

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Table 5 Relationship between immune-nutritional score and postoperative complications, n (%)

Variables	Low-INS group (n = 155)	High-INS group (n = 92)	χ²	P value
Clavien-Dindo grade
Grade I-II	4 (2.58)	58 (63.04)	-	-
Grade ≥ III	1 (0.65)	19 (20.65)	-	-
Types of complications
Pulmonary infection	1 (0.65)	21 (22.83)	-	-
Surgical site infection	1 (0.65)	10 (10.87)	-	-
Anastomotic leakage	1 (0.65)	11 (11.96)	-	-
Postoperative hemorrhage	1 (0.65)	9 (9.78)	-	-
Intestinal obstruction	1 (0.65)	11 (11.96)	-	-
Intra-abdominal infection	0 (0.00)	7 (7.61)	-	-
Other complications	0 (0.00)	8 (8.7)	-	-
Incidence of postoperative complications	5 (3.23)	77 (83.7)	168.57	< 0.001

INS: Immune-nutritional score.

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Citation: Liu WL, Liu HN, Cao MH, Wang HM, Qin XB, Tang JJ, Zhao Y, Ge Y, Han ZX. Immune-nutritional score-based prognostic model for predicting postoperative complications and survival in gastric cancer. World J Gastrointest Surg 2026; 18(7): 119514
URL: https://www.wjgnet.com/1948-9366/full/v18/i7/119514.htm
DOI: https://dx.doi.org/10.4240/wjgs.v18.i7.119514

Liu WL, Liu HN, Cao MH, Wang HM, Qin XB, Tang JJ, Zhao Y, Ge Y, Han ZX. Immune-nutritional score-based prognostic model for predicting postoperative complications and survival in gastric cancer. World J Gastrointest Surg 2026; 18(7): 119514 [DOI: 10.4240/wjgs.v18.i7.119514]

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