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

Table 1 Scoring criteria for inflammation/nutrition-based combined score

Marker	Cut-off definition	Assigned score
NLR	≥ 2.75	1
PLR	≥ 178	1
PNI	40–45	1
	< 40	2
PI	CRP > 1.0 mg/dL or WBC > 11000/mm3	1
	CRP > 1.0 mg/dL and WBC > 11000/mm3	2

CRP: C-reactive protein; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; PNI: Prognostic nutritional index; PI: Prognostic index; WBC: White blood cell count.

Table 2 Baseline demographic and clinical characteristics stratified by inflammation/nutrition-based combined score, median (interquartile range)/n (%)

Variable	Total (n = 154)	Low score (0-3, n = 121)	High score (4-6, n = 33)	P value
Age (years)	68 (61-76)	67 (60-74)	75 (70-83)	< 0.001a
Sex (male)	96 (62.3)	78 (64.5)	18 (54.5)	0.401
Type of surgery				0.050
Subtotal	59 (38.3)	41 (33.9)	18 (54.5)
Total	95 (61.7)	80 (66.1)	15 (45.5)
Neoadjuvant chemotherapy	29 (18.8)	25 (20.7)	4 (12.1)	0.389
Overall mortality	94 (61.0)	65 (53.7)	29 (87.9)	< 0.001a
TNM stage	n = 151			0.016a
Stage I	19 (12.6)	18 (14.9)	1 (3.0)
Stage II	45 (29.8)	39 (32.2)	6 (18.2)
Stage III	65 (43.0)	48 (39.7)	17 (51.5)
Stage IV	22 (14.6)	13 (10.7)	9 (27.3)
Perineural invasion	107/153 (69.9)	79 (65.3)	28 (84.8)	0.058
Differentiation (poor)	n = 108			0.136
Poor	48 (44.4)	36 (29.8)	12 (36.4)
Moderate	43 (39.8)	30 (24.8)	13 (39.4)
Good	17 (15.7)	16 (13.2)	1 (3.0)

^aP < 0.05.

Mann Whitney U test was used for age, and χ² was used for the categoric variables. The total number (n) of available cases for variables with missing data is indicated separately. TNM: Tumor-node-metastasis.

Table 3 Laboratory characteristics stratified by inflammation/nutrition-based combined score, median (interquartile range)

Variable	Low score (0-3)	High score (4-6)	P value
WBC (× 109/L)	6.55 (5.44-7.67)	7.29 (5.56-9.85)	0.058
Neutrophil (× 109/L)	3.88 (2.96-4.95)	5.78 (3.61-7.79)	< 0.001c
Lymphocyte (× 109/L)	1.79 (1.41-2.21)	1.02 (0.79-1.41)	< 0.001c
Platelet (× 109/L)	259 (218-315)	303 (241-373)	0.002b
CRP (mg/L)	8.1 (3.4-18.0)	29.2 (13.6-54.4)	< 0.001c
NLR	2.22 (1.68-3.01)	5.29 (4.07-8.19)	< 0.001c
PLR	150 (112.5-202.6)	284.96 (197.6-379.8)	< 0.001c
PNI	46.9 (43.45-51.15)	36.25 (31.7-38.9)	< 0.001c

^bP < 0.01.

^cP < 0.001.

Mann-Whitney U test was used for all variables. CRP: C-reactive protein; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; PNI: Prognostic nutritional index; WBC: White blood cell count.

Table 4 Multivariable Cox regression analysis including tumor-node-metastasis stage

Variable	HR	95%CI (lower)	95%CI (upper)	P value
INCS	1.14	0.99	1.31	0.070
Age	1.02	1.00	1.05	0.030
Perineural invasion	0.96	0.51	1.83	0.910
Neoadjuvant therapy	2.72	1.56	4.74	< 0.005
TNM stage (1-4)	2.79	2.01	3.86	< 0.005
Surgical type	1.02	0.66	1.59	0.930

Inflammation/nutrition-based combined score (0-6) and tumor-node-metastasis stage (1-4) were treated as ordinal variables. Multivariable Cox proportional hazards regression analysis was used to calculate hazard ratios and 95%CI (concordance index: 0.73). HR: Hazard ratio; INCS: Inflammation/nutrition-based combined score; TNM: Tumor-node-metastasis.