Preoperative PNI-dNLR Score as Predicting Long-Term Survival in Older Adults Undergoing Radical Gastrectomy for Gastric Cancer

Objective: This study aimed to assess the prognostic value of preoperative peripheral blood-based inflammatory and nutritional indices in older adults diagnosed with gastric cancer (GC) undergoing radical gastrectomy and to develop a novel composite prognostic score. Methods: A retrospective single-center analysis of clinicopathologic data of 609 older adults diagnosed with GC who underwent radical gastrectomy at the Affiliated Hospital of Putian University between 2012 and 2020, was conducted. Multivariate Cox regression analysis was performed to identify independent prognostic factors. A composite score, termed the PNI-dNLR, was constructed using the prognostic nutritional index (PNI) and derived neutrophil-to-lymphocyte ratio (dNLR), and its predictive performance was assessed. Results: Multivariate Cox regression identified both preoperative PNI (hazard ration HR, 0.74; 95% confidence interval CI, 0.57– 0.97; p = 0.027) and dNLR (HR, 1.44; 95% CI, 1.06– 1.94; p = 0.018) as independent prognostic indicators for overall survival (OS) and disease-free survival (DFS). The PNI-dNLR score, derived from these two variables, demonstrated favorable predictive performance as assessed by the Akaike information criterion, Bayesian information criterion, time-dependent concordance index, and time-dependent receiver operating characteristic curve analysis. The PNI-dNLR remained an independent predictor of OS and DFS in multivariate Cox regression models ( p < 0.05). Further validation using least absolute shrinkage and selection operator-Cox regression, random survival forest, and survival tree modeling, along with intersecting features from multivariate Cox analysis, supported the prognostic significance of the PNI-dNLR score in this population. Conclusion: Preoperative dNLR and PNI independently predicted long-term postoperative outcomes in older adults undergoing radical gastrectomy for GC. The combined PNI-dNLR score demonstrated predictive value, which need further prospective multicenter study conducting internal and external validation to confirm before clinic application for risk stratification, personalized prognostic assessment, and treatment planning in this patient population. Keywords: combined prediction, disease-free survival, elderly patients with gastric cancer, inflammatory indicators, nutritional indicators, overall survival