A novel composite score based on NLR, PLR, and PNI for constructing a nomogram to predict overall survival in patients with gastric cancer

OBJECTIVE: This study aimed to develop an NPPs composite score integrating the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and prognostic nutritional index (PNI) as a comprehensive measure of host nutritional status and immune-inflammatory response. The association between the NPPs composite score and survival outcomes in patients with gastric cancer was further evaluated using a prognostic nomogram. METHODOLOGY: A total of 206 patients who underwent radical gastrectomy for gastric cancer between May 2019 and April 2021 were retrospectively enrolled and followed after surgery. The median follow-up time was 36 months. Overall survival (OS), defined as the interval from surgery to death or last follow-up, was the primary endpoint. All candidate predictors used to construct the prognostic model were collected preoperatively. Survival probabilities were assessed using the Kaplan-Meier method, and univariable and multivariable Cox proportional hazards regression analyses were performed based on survival time and survival status to identify independent prognostic factors. A nomogram for predicting OS was then developed and internally evaluated using bootstrap resampling, the concordance index (C-index), calibration curves, and decision curve analysis. Time-dependent ROC analyses were also performed to assess prognostic discrimination at predefined time points. RESULTS: Kaplan-Meier analysis revealed that patients with a high NPPs composite score had significantly worse overall survival (log-rank P < 0.001). Multivariable Cox regression analysis identified age (hazard ratio [HR] > 1, P < 0.001), vascular invasion (HR > 1, P = 0.016), and NPPs composite score (HR > 1, P < 0.001) as independent factors associated with OS. Furthermore, the nomogram demonstrated excellent discrimination (C-index = 0.858, 95% CI 0.828-0.889) and exhibited favorable clinical utility based on decision curve analysis. CONCLUSION: The NPPs composite score was independently associated with OS in patients with gastric cancer after radical surgery. The nomogram based on survival-time analysis may be useful for individualized postoperative prognostic assessment; however, its clinical applicability should be interpreted cautiously until further external validation is performed.