Prognostic value of the prognostic immune-inflammatory-nutritional score in patients with advanced gastric cancer treated with immunochemotherapy

doi:10.4251/wjgo.122724

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. Oct 15, 2026; 18(10): 122724
Published online Oct 15, 2026. doi: 10.4251/wjgo.122724

Prognostic value of the prognostic immune-inflammatory-nutritional score in patients with advanced gastric cancer treated with immunochemotherapy

Qiu-Lin Hao, Zheng-Yu Li, Zhi-Yuan Yao, Yu-Meng Shen, Dong-Shan Sun, Chao Gao, Ran-Ran Jiang

Qiu-Lin Hao, Zheng-Yu Li, Zhi-Yuan Yao, Yu-Meng Shen, Dong-Shan Sun, Chao Gao, Ran-Ran Jiang, Center of Clinical Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu Province, China

Co-first authors: Qiu-Lin Hao and Zheng-Yu Li.

Co-corresponding authors: Chao Gao and Ran-Ran Jiang.

Author contributions: Hao QL and Li ZY made equal contributions to writing the original draft as co-first authors; Hao QL, Gao C, and Jiang RR designed the research; Li ZY, Yao ZY, and Shen YM have made contributions to data collection and organization; Sun DS conducted statistical analysis; Gao C and Jiang RR have played important roles in the experimental design as co-corresponding authors; all authors have read and approved the final manuscript.

AI contribution statement: Some text in this manuscript has been edited with the aid of AI tools, solely for language enhancement and proofreading purposes. All authors have carefully reviewed and verified the content generated with the assistance of AI, and bear full responsibility for the scientific content of the manuscript. The AI tools did not participate in the generation of original scientific data, independent scientific analysis, nor were they used to form scientific conclusions.

Supported by the Advanced Program of The Affiliated Hospital of Xuzhou Medical University, No. PYJH2025312; and The Affiliated Hospital of Xuzhou Medical University, No. 2023ZL07.

Institutional review board statement: This study was approved by the Ethics Committee of the Affiliated Hospital of Xuzhou Medical University (approval No. XYFY2023-KL277-01) and was conducted in accordance with the principles of the Declaration of Helsinki.

Informed consent statement: Due to the retrospective nature of this study, the requirement for written informed consent was waived by the Ethics Committee of the Affiliated Hospital of Xuzhou Medical University.

Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.

Data sharing statement: Data underlying this study are available upon request from the corresponding author at xyfyjrr@126.com.

Corresponding author: Ran-Ran Jiang, MD, PhD, Professor, Center of Clinical Oncology, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai Road, Xuzhou 221002, Jiangsu Province, China. xyfyjrr@126.com

Received: April 27, 2026
Revised: May 27, 2026
Accepted: June 29, 2026
Published online: October 15, 2026
Processing time: 145 Days and 20.1 Hours

Abstract

BACKGROUND

Reliable and readily available prognostic biomarkers for advanced gastric cancer (AGC) treated with immunochemotherapy remain limited.

AIM

To evaluate the prognostic value of the prognostic immune-inflammatory-nutritional (PIIN) score in patients with AGC receiving first-line sintilimab plus chemotherapy and to develop clinically applicable prognostic models.

METHODS

In this single-center retrospective study, 200 patients with human epidermal growth factor receptor 2-negative unresectable locally AGC treated at the Affiliated Hospital of Xuzhou Medical University were included. The optimal PIIN cutoff was determined by receiver operating characteristic analysis, and patients were stratified into low-PIIN and high-PIIN groups. The Kaplan-Meier method and Cox regression analyses were employed to estimate progression-free survival (PFS) and overall survival (OS). Nomograms were constructed based on independent prognostic factors and internally validated.

RESULTS

The optimal PIIN cutoff for OS prediction was 25.69, with an area under the curve of 0.71 (95%CI: 0.64-0.78). Compared with the high-PIIN group, the low-PIIN group had significantly longer median PFS (14.5 months vs 7.5 months, P = 0.032) and OS (27.7 months vs 15.0 months, P < 0.001), as well as a higher disease control rate (77.94% vs 62.12%, P = 0.024), whereas the objective response rate did not differ significantly. Multivariable analysis identified PIIN, programmed death-ligand 1 expression, mismatch repair status, TNM stage, and Eastern Cooperative Oncology Group performance status as independent prognostic factors. Nomograms incorporating these variables showed good discrimination and calibration, with C-indices of 0.78 and 0.79 for PFS and 0.75 and 0.73 for OS in the training and validation cohorts, respectively.

CONCLUSION

PIIN is an independent prognostic biomarker for survival outcomes in patients with AGC receiving first-line sintilimab plus chemotherapy. A lower PIIN is associated with improved PFS, OS, and disease control, and the PIIN-based nomograms may facilitate individualized prognostic assessment and treatment decision-making.

Keywords: Gastric cancer; Prognostic immune-inflammatory-nutritional score; Programmed death-1 inhibitor; Predictive model; Immunochemotherapy

Core Tip: Advanced gastric cancer shows poor prognosis and heterogeneous response to first-line immunochemotherapy. The prognostic immune-inflammatory-nutritional (PIIN) score, combining neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, fibrinogen, albumin-bilirubin, and prognostic nutritional index, independently predicts survival in advanced gastric cancer patients treated with sintilimab plus chemotherapy. Lower PIIN scores correlate with longer progression-free survival, overall survival, and higher disease control. Nomograms integrating PIIN, TNM stage, programmed death-ligand 1, mismatch repair status, and Eastern Cooperative Oncology Group performance status provide individualized prognostic assessment to guide treatment.