Prognostic value of the combined fibrinogen and prognostic nutritional index score in resectable gastric cancer

Objective This study aimed to evaluate the prognostic value of the preoperative fibrinogen and prognostic nutritional index (PNI) combination score (F-PNI) in predicting long-term survival following radical gastrectomy in patients diagnosed with resectable gastric cancer. Methods A retrospective cohort analysis was performed using clinicopathological and follow-up data from 491 patients who underwent radical gastrectomy for gastric cancer at a single tertiary institution between January 2012 and December 2017. Statistical analyses were conducted using SPSS version 25.0 to identify independent prognostic factors associated with five-year overall survival. Results The optimal preoperative cut-off values were identified as 3.335 mg/L for fibrinogen and 52.7 for the PNI. The area under the receiver operating characteristic curve (AUC) for the F-PNI score was 0.633, demonstrating higher discriminative ability compared to PNI alone (AUC = 0.592) and fibrinogen alone (AUC = 0.587). Kaplan–Meier survival analysis showed five-year survival rates as follows: low vs. high fibrinogen levels, 72.9% vs. 56.4%; high vs. low PNI, 82.6% vs. 58.0%; and F-PNI score 0, 1, and 2, 87.8%, 66.9%, and 50.0%, respectively. Both univariate and multivariate Cox proportional hazards models identified a high F-PNI score, advanced age, pathological TNM stage IIIA–IIIC, and vascular invasion as independent prognostic factors for five-year survival. The F-PNI score demonstrated superior prognostic performance compared to either fibrinogen or PNI alone. Conclusion The F-PNI combination score is an independent prognostic marker for long-term survival in patients undergoing radical resection for resectable gastric cancer. Its enhanced predictive accuracy relative to fibrinogen or PNI individually suggests potential utility in preoperative prognostic stratification.