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

Table 1 Baseline characteristics (n = 195), n (%)

Variables	Low-risk group (n = 65)	Moderate-risk group (n = 65)	High-risk group (n = 65)	Statistic	P value
Age (years)	58.5 ± 7.9	59.1 ± 8.4	60.2 ± 8.7	F = 0.832	0.412
Gender				χ² = 0.256	0.879
Male	38 (58.5)	39 (60.0)	40 (61.5)
Female	27 (41.5)	26 (40.0)	25 (38.5)
BMI (kg/m2)	23.7 ± 2.0	23.8 ± 2.1	23.5 ± 2.2	F = 0.356	0.701
Education level				χ² = 0.287	0.772
Junior high or below	15 (23.1)	14 (21.5)	16 (24.6)
High school	25 (38.5)	26 (40.0)	24 (36.9)
College or above	25 (38.5)	25 (38.5)	25 (38.5)
Surgical method				χ² = 0.521	0.681
Minimally invasive surgery	50 (76.9)	48 (73.8)	51 (78.5)
Open surgery	15 (23.1)	17 (26.2)	14 (21.5)
Type of surgery				χ² = 0.132	0.936
Total gastrectomy	33 (50.8)	34 (52.3)	32 (49.2)
Partial gastrectomy	32 (49.2)	31 (47.7)	33 (50.8)
Clinical staging				χ² = 0.217	0.897
Phase I	10 (15.4)	12 (18.5)	11 (16.9)
Phase II	20 (30.8)	19 (29.2)	21 (32.3)
Phase III	25 (38.5)	24 (36.9)	23 (35.4)
Phase IV	10 (15.4)	10 (15.4)	10 (15.4)
Comorbidities				χ² = 0.156	0.991
Hypertension	15 (23.1)	16 (24.6)	17 (26.2)
Diabetes	10 (15.4)	11 (16.9)	12 (18.5)
Other	5 (7.7)	6 (9.2)	7 (10.8)

P values were adjusted using Bonferroni correction where applicable. Missing data were handled using the linear mixed model. BMI: Body mass index.

Table 2 Sleep quality (Pittsburgh Sleep Quality Index scores)

Group	Pre-op PSQI	1 week post-op	1 month post-op	1 year post-op	Improvement	Statistic	P value
Low-risk	10.1 ± 3.2	8.5 ± 3.1	7.0 ± 2.6	6.3 ± 2.4	-3.8 ± 2.1	F = 13.56	0.032
Moderate-risk	11.3 ± 4.0	8.9 ± 3.5	6.7 ± 2.8	5.4 ± 2.1	-5.9 ± 2.5	F = 15.21	0.014
High-risk	12.6 ± 4.3	9.3 ± 3.8	5.6 ± 2.3	4.1 ± 1.8	-8.5 ± 2.71	F = 17.98	< 0.001

¹Indicates statistically significant difference compared to other groups (P < 0.01). P values were adjusted using Bonferroni correction where applicable. Missing data were handled using the linear mixed model.

Lower scores indicate better sleep quality. “Improvement” refers to change from baseline (Δ value).

PSQI: Pittsburgh Sleep Quality Index.

Table 3 Temporal changes in body mass index, serum albumin, and Prognostic Inflammatory and Nutritional Index scores across risk groups

Group	Pre-op BMI	1W Post-op	1M Post-op	1Y Post-op	BMI Δ	Pre-op Albumin	1W Post-op	1M Post-op	1Y Post-op	Albumin Δ	Pre-op PINI	1W Post-op	1M Post-op	1Y Post-op	PINI Δ
Low-risk	23.8 ± 2.0	22.9 ± 1.8	23.2 ± 1.7	23.6 ± 1.5	-0.2 ± 0.2	42.3 ± 4.5	43.0 ± 4.3	43.8 ± 4.0	44.2 ± 3.9	+1.9 ± 1.2	1.2 ± 0.2	1.1 ± 0.2	0.9 ± 0.2	0.8 ± 0.1	-0.4 ± 0.2
Moderate-risk	23.6 ± 2.1	23.0 ± 2.0	23.5 ± 1.8	23.9 ± 1.6	-0.1 ± 0.3	41.5 ± 5.2	43.5 ± 4.9	44.7 ± 4.5	45.3 ± 4.3	+3.8 ± 1.6	2.5 ± 0.3	2.1 ± 0.3	1.8 ± 0.3	1.5 ± 0.2	-1.0 ± 0.3
High-risk	23.4 ± 2.3	23.1 ± 2.1	23.7 ± 2.0	24.2 ± 1.8	+0.1 ± 0.21	40.2 ± 5.0	45.0 ± 4.4	46.8 ± 4.2	47.5 ± 3.8	+6.5 ± 2.31	4.6 ± 0.4	3.8 ± 0.3	3.2 ± 0.3	2.7 ± 0.2	-1.9 ± 0.41

¹Indicates statistically significant difference compared to other groups (P < 0.01). This table summarizes longitudinal changes in body mass index, serum albumin levels, and Prognostic Inflammatory and Nutritional Index scores across low-, moderate-, and high-risk groups. Values represent mean ± SD. “Improvement” denotes change from baseline.

BMI: Body mass index; PINI: Prognostic Inflammatory and Nutritional Index.

Table 4 Time-course of Self-Rating Anxiety Scale and Self-Rating Depression Scale scores across risk groups

Group	Pre-op SAS	1W	1M	1Y	SAS Δ	Pre-op SDS	1W	1M	1Y	SDS Δ
Low-risk	46.2 ± 8.3	44.5 ± 7.8	42.7 ± 7.1	40.9 ± 6.8	-5.3 ± 2.2	45.8 ± 7.9	43.9 ± 7.5	41.6 ± 7.0	39.8 ± 7.3	-6.0 ± 2.4
Moderate-risk	48.4 ± 9.0	45.9 ± 8.7	43.8 ± 8.4	41.1 ± 7.9	-7.3 ± 2.6	47.5 ± 8.6	44.5 ± 8.3	42.1 ± 7.9	38.9 ± 7.7	-8.6 ± 2.9
High-risk	50.1 ± 9.5	44.3 ± 8.2	39.6 ± 7.2	37.2 ± 6.4	-12.9 ± 3.11	49.9 ± 9.3	44.1 ± 8.1	39.3 ± 7.5	35.6 ± 6.1	-12.6 ± 4.21

¹Indicates statistically significant difference compared to other groups (P < 0.01). This table presents changes in psychological outcomes measured by the Self-Rating Anxiety Scale and Self-Rating Depression Scale at multiple postoperative time points. Values represent mean ± SD. “Improvement” indicates change from baseline.

SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale.

Table 5 Pain levels (Visual Analog Scale scores)

Group	Pre-op VAS	1 week post-op	1 month post-op	1 year post-op	Improvement	Statistic	P value
Low-risk	6.9 ± 2.3	5.1 ± 2.0	3.9 ± 1.8	3.2 ± 1.5	-3.7 ± 1.3	F = 10.87	0.028
Moderate-risk	7.2 ± 2.5	5.3 ± 2.1	3.7 ± 1.9	2.9 ± 1.4	-4.3 ± 1.5	F = 11.45	0.014
High-risk	7.5 ± 2.6	4.8 ± 1.9	3.2 ± 1.6	2.1 ± 1.3	-5.4 ± 1.61	F = 13.78	< 0.001

¹Indicates statistically significant difference compared to other groups (P < 0.01).

Lower scores indicate less pain. P values were adjusted using Bonferroni correction where applicable. Missing data were handled using the linear mixed model. “Improvement” refers to change from baseline (Δ value). VAS: Visual Analog Scale for pain (range: 0-10).

Table 6 Quality of life (EORTC QLQ-C30 scores)

Group	Pre-op QOL	1 week post-op	1 month post-op	1 year post-op	Improvement	Statistic	P value
Low-risk	58.7 ± 11.1	64.3 ± 10.4	70.1 ± 8.9	75.0 ± 7.6	16.3 ± 4.8	F = 7.86	0.031
Moderate-risk	53.5 ± 9.2	62.4 ± 8.3	67.2 ± 7.4	73.8 ± 6.9	20.3 ± 5.1	F = 10.13	0.012
High-risk	49.8 ± 13.0	63.5 ± 10.5	71.1 ± 8.9	78.2 ± 8.0	28.4 ± 6.31	F = 15.49	< 0.001

¹Indicates statistically significant difference compared to other groups (P < 0.01).

Higher scores indicate better quality of life. P values were adjusted using Bonferroni correction where applicable. Missing data were handled using the linear mixed model. “Improvement” refers to change from baseline (Δ value). EORTC QLQ-C30: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.

Table 7 Postoperative complications & prognosis

Group	Complication rate	Mean hospital stay (days)	6-month survival rate	1-year survival rate	Statistic	P value
Low-risk	10.0% (7/65)	12.3 ± 3.1	96.7% (63/65)	93.8% (61/65)	χ² = 6.42	0.004
Moderate-risk	16.7% (11/65)	11.2 ± 2.9	93.3% (61/65)	90.2% (59/65)	F = 6.89	0.003
High-risk	3.3% (2/65)	9.8 ± 2.4	100% (65/65)	98.5% (64/65)	χ² = 1.89	0.192

Complication rates are presented as percentages. Hospital stay is reported as mean ± SD (days). Survival rates are presented as percentages. P values were adjusted using Bonferroni correction where applicable. Missing data were handled using the linear mixed model.

Table 8 Correlation analysis between Prognostic Inflammatory and Nutritional Index score improvement and recovery outcomes

Variable	Pearson correlation coefficient (r)	P value	Interpretation
PSQI score improvement	0.68	< 0.01	Better sleep quality
SAS score reduction	0.65	< 0.01	Lower anxiety levels
SDS score reduction	0.61	< 0.01	Reduced depressive symptoms
EORTC QLQ-C30 improvement	0.72	< 0.01	Better quality of life
Postoperative complication rate	-0.59	< 0.01	Lower risk of postoperative complications

Pearson correlation coefficients (r) indicate the strength and direction of associations. Positive values indicate direct correlations, while negative values indicate inverse correlations. P values were adjusted using Bonferroni correction where applicable. Missing data were handled using the linear mixed model.