Prognostic immune nutritional index-based nutritional stratification enhances recovery and survival in gastric cancer: A randomized controlled trial

doi:10.5306/wjco.v16.i9.110068

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Sep 24, 2025 (publication date) through Oct 27, 2025

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World Journal of Clinical Oncology

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Randomized Controlled Trial

World J Clin Oncol. Sep 24, 2025; 16(9): 110068
Published online Sep 24, 2025. doi: 10.5306/wjco.v16.i9.110068

Prognostic immune nutritional index-based nutritional stratification enhances recovery and survival in gastric cancer: A randomized controlled trial

Gang Wang, Sheng-Jie Pan

Gang Wang, Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China

Sheng-Jie Pan, Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China

Author contributions: Wang G contributed to writing-original draft; Wang G and Pan SJ contributed to conceptualization, supervision, writing-review & editing; All authors have read and approved the final version of the manuscript.

Institutional review board statement: The experimental protocol was established, according to the ethical guidelines of the Helsinki Declaration and was approved by the Human Ethics Committee of the Medical Ethics Committee of the First Affiliated Hospital of Soochow University. Written informed consent was obtained from individual or guardian participants.

Clinical trial registration statement: This clinical trial has been submitted for registration with an internationally recognized registry. The registration application includes all essential trial details, including study objectives, design, intervention protocols, and outcome measures. The trial registration number will be provided upon approval. We affirm that the study was designed and initiated in accordance with ethical and regulatory standards, and full transparency will be maintained upon completion of the registration process.

Informed consent statement: Every human participant gave consent to participate in the study.

Conflict-of-interest statement: All authors have reviewed and approved the final manuscript, and there are no conflicts of interest in the study.

CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.

Data sharing statement: This study provides all safe and available data, and all data generated or analyzed during this study are included in this published article.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Sheng-Jie Pan, MD, PhD, Professor, Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou 215006, Jiangsu Province, China. 448331812@qq.com

Received: May 29, 2025
Revised: June 9, 2025
Accepted: August 25, 2025
Published online: September 24, 2025
Processing time: 117 Days and 22.6 Hours

Abstract

BACKGROUND

Postoperative malnutrition, systemic inflammation, and immune dysfunction significantly impair recovery and survival in gastric cancer patients undergoing radical gastrectomy. The Prognostic Immune Nutritional Index (PINI) enables immune-nutritional risk stratification; however, its utility in guiding perioperative nutritional support remains underexplored.

AIM

To evaluate whether risk-stratified perioperative nutritional support based on PINI scores improves postoperative recovery, quality of life, and long-term outcomes in gastric cancer patients.

METHODS

In this prospective, randomized controlled trial, 195 patients undergoing radical gastrectomy were stratified into low- (PINI ≤ 1.5), moderate- (1.5 < PINI ≤ 3), and high-risk (PINI > 3) groups. Patients received standard, intensive, or immune-enhancing nutritional support, respectively. Outcomes were assessed at 1 week, 1 month, and 1 year postoperatively and included body mass index (BMI), serum albumin, PINI scores, Pittsburgh Sleep Quality Index (PSQI), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Visual Analog Scale (VAS) for pain, EORTC QLQ-C30 for quality of life, complication rates, hospital stay, and survival.

RESULTS

At 1 year, the high-risk group receiving immune-enhancing nutrition demonstrated the greatest improvements, with higher serum albumin (47.5 ± 3.8 g/L) and stabilized BMI (+0.1 ± 0.2 kg/m²vs -0.2 ± 0.2 kg/m² in the low-risk group, P < 0.01). Sleep quality (ΔPSQI: -8.5 ± 2.7), anxiety (ΔSAS: -12.9 ± 3.1), and depression (ΔSDS: -12.6 ± 4.2) improved significantly (all P < 0.01). Pain scores were lowest (VAS: 2.1 ± 1.3), and quality of life was highest (78.2 ± 8.0, P < 0.01). The high-risk group also had the lowest complication rate (3.3%), shortest hospital stay (9.8 ± 2.4 days), and highest 1-year survival (98.5%, P < 0.05).

CONCLUSION

PINI-based graded nutritional support significantly enhances postoperative recovery, reduces complications, and improves long-term outcomes following radical gastrectomy. These findings support its integration into precision perioperative care strategies for gastric cancer.

Keywords: Prognostic Immune Nutritional Index; Gastric cancer; Perioperative nutrition; Postoperative recovery; Quality of life

Core Tip: This randomized controlled trial is the first to apply Prognostic Immune Nutritional Index (PINI)-based risk stratification to guide perioperative nutritional support in gastric cancer patients. The tailored interventions significantly improved sleep quality, psychological well-being, nutritional status, and 1-year survival, particularly in high-risk individuals. Our findings highlight the value of individualized immune-enhancing nutrition in optimizing recovery and suggest that PINI may serve as a practical tool for precision perioperative care.