Background/Aim: Conversion surgery can prolong survival in initially unresectable gastric cancer when curative (R0) resection is achieved; however, pre-treatment predictors of R0 conversion remain limited. We investigated whether the Gustave Roussy Immune (GRIm) score predicts R0 resection and survival in patients considered for conversion surgery. Patients and Methods: We retrospectively analyzed 57 patients with unresectable advanced gastric cancer treated with systemic chemotherapy from January 2019 to July 2025. Patients were classified as achieving conversion (AC; conversion surgery with R0 resection) or non-conversion (NC). The GRIm score (albumin, lactate dehydrogenase, and neutrophil-to-lymphocyte ratio) and clinicopathological variables were evaluated as predictors of R0 resection using univariate and multivariate logistic regression. Overall survival (OS) was assessed using the Kaplan-Meier method. Results: Ten patients (17.5%) achieved R0 resection. The AC group had lower GRIm scores and a more favorable Yoshida classification than the NC group, and intestinal-type histology was more frequent in the AC group. In multivariate analysis, a low GRIm score (0-1) and Yoshida classification C1-2 were independently associated with R0 resection. OS was significantly longer in patients with low GRIm scores than in those with high scores. Conclusion: The GRIm score is an accessible pre-treatment biomarker associated with successful R0 conversion surgery and improved survival in unresectable gastric cancer and may complement the Yoshida classification in candidate selection.
NAGATA et al. (Mon,) studied this question.