Gastric cancer (GC), the fifth leading cause of global cancer mortality, imposes significant clinical and economic burdens, particularly in high-incidence regions such as East Asia. Despite advancements in treatment, postoperative complications persist in 12.8-14% of patients, with malnutrition being a critical risk factor. Geographic variations in treatment paradigms (e.g., predominant neoadjuvant therapy in the West vs. upfront surgery in East Asia for selected stage III) necessitate region-specific prognostic analyses of the same. This study evaluated the prognostic role of preoperative nutritional indices, the Prognostic Nutritional Index (PNI) and Nutritional Risk Screening 2002 (NRS-2002), using a dual approach: a meta-analysis of 27 global cohorts (2016-2023, n=19,285 patients) and a retrospective cohort study (n = 203 patients, 2021-2024). Pooled meta-analysis revealed that low preoperative PNI was significantly correlated with reduced overall survival (OS: multifactorial study HR = 1.344, 95% CI = 1.111-1.625, P < 0.001; univariate study HR = 3.140, 95% CI = 1.564-6.302) and disease-free survival (DFS: multifactorial study HR = 0.977, 95% CI = 0.667-1.432, P < 0.001; univariate study HR = 2.890, 95% CI = 2.236-3.735, P = 0.185), alongside increased risks of infectious complications (RR = 0.665, 95% CI = 0.544-0.814, P < 0.001). Retrospective data demonstrated that the combined PNI and NRS-2002 assessment improved the predictive accuracy for early postoperative complications (AUC=0.657 vs. 0.541 for PNI alone). Patients with complications experienced prolonged hospitalization (Δ = 6.31 days, P < 0.001) and higher costs. Multivariate analysis identified low PNI (OR = 2.24) and high NRS-2002 (OR = 2.49) as independent predictors of adverse outcomes. These findings underscore the necessity of integrating preoperative nutritional screening into clinical protocols to stratify high-risk patients, guide targeted interventions, and mitigate the economic burden associated with postoperative morbidity. Our multidimensional model highlights the synergistic value of combining immunonutritional biomarkers with conventional risk tools, offering a translatable framework for optimizing perioperative care in GC. While our findings reflect gastric cancer management in high-incidence regions, validation in Western cohorts undergoing neoadjuvant therapy is required.
Zheng et al. (Mon,) studied this question.
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