Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2025; 17(5): 102201
Published online May 27, 2025. doi: 10.4240/wjgs.v17.i5.102201
Novel inflammatory-nutritional prognostic index for advanced gastric cancer patients undergoing gastrectomy and prophylactic hyperthermic intraperitoneal chemotherapy
Liang Wang, Mei-Zhu Chen, Lei Liu, Zi-Nian Jiang, Si-Meng Zhang, Mao-Shen Zhang, Xian-Xiang Zhang, Rui-Qing Liu, Dong-Sheng Wang
Liang Wang, Lei Liu, Zi-Nian Jiang, Si-Meng Zhang, Mao-Shen Zhang, Xian-Xiang Zhang, Rui-Qing Liu, Dong-Sheng Wang, Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266555, Shandong Province, China
Liang Wang, Dong-Sheng Wang, Qingdao Medical College, Qingdao University, Qingdao 266071, Shandong Province, China
Mei-Zhu Chen, Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266555, Shandong Province, China
Co-first authors: Liang Wang and Mei-Zhu Chen.
Co-corresponding authors: Rui-Qing Liu and Dong-Sheng Wang.
Author contributions: All authors read and approved the final manuscript; Wang DS, Liu RQ, Wang L, Chen MZ, Zhang MS, Zhang XX contributed to the study’s conception and design; Wang L, Liu L, and Jiang ZN were responsible for patient screening and data collection. Wang L, Chen MZ, and Zhang SM analyzed the data and made the figures and tables. Wang L, Chen MZ, and Liu RQ completed the first draft of the article. Wang DS, Liu RQ, Wang L, and Chen MZ participated in revising the manuscript before submission and during the formal revision. Wang L and Chen MZ contributed equally as co-first authors; During the creation and publication of this article, Liu RQ and Wang DS, as co-corresponding authors, made significant contributions to each key aspect. Wang DS took the lead in designing the research plan, ensuring its scientificity, feasibility, and innovation. Meanwhile, Wang DS was responsible for coordinating various resources to guarantee the smooth progress of the research work. Liu RQ was deeply involved in the experimental process, including specific tasks such as data collection and chart making. During the writing of the paper, Liu RQ systematically sorted out and analyzed the research results and wrote key chapters, making the expressions more accurate, fluent, and the logic more rigorous.
Institutional review board statement: The study was reviewed and approved by the institutional Ethics Committee of Affiliated Hospital of Qingdao University (No. QYFY WZLL28242).
Informed consent statement: The requirement of informed consent for enrolled patients was waived by the Institutional Ethics Committee because of the retrospective study design.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets during the current study available from the corresponding author on reasonable request at wangdongsheng@qdu.edu.cn.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong-Sheng Wang, MD, Professor, Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Huangdao District, Qingdao 266555, Shandong Province, China. wangdongsheng@qdu.edu.cn
Received: October 11, 2024
Revised: February 13, 2025
Accepted: March 21, 2025
Published online: May 27, 2025
Processing time: 223 Days and 13.4 Hours
Abstract
BACKGROUND

Prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) is one of the methods to prevent peritoneal metastasis of advanced gastric cancer (AGC). However, the prognosis of gastric cancer patients who receive this treatment are different.

AIM

To investigate whether inflammation and nutritional indicators affect the prognosis of AGC patients undergoing gastrectomy and prophylactic HIPEC, and to develop a novel inflammatory nutritional prognostic index (INPI). Additionally, we aimed to construct a nomogram model to visually predict the prognosis of these patients and provide more accurate guidance for clinical decision-making.

METHODS

Clinical data from 181 Locally AGC patients who underwent gastrectomy and prophylactic HIPEC treatment at The Affiliated Hospital of Qingdao University were retrospectively collected. Multicollinearity analysis and least absolute shrinkage and selection operator (LASSO) Cox regression were utilized to construct the INPI. Survival analyses were performed using the Kaplan-Meier method and log-rank test. Both univariate and multivariate Cox proportional hazards regression models were used to analyze independent prognostic factors, and a prognostic nomogram was generated. And the model was validated using the bootstrap method.

RESULTS

Clinical data from 181 locally AGC patients who underwent gastrectomy and prophylactic HIPEC treatment at The Affiliated Hospital of Qingdao University were retrospectively collected. Multicollinearity analysis and LASSO Cox regression were utilized to construct the INPI. Survival analyses were performed using the Kaplan-Meier method and log-rank test. Both univariate and multivariate Cox proportional hazards regression models were applied to analyze independent prognostic factors, and a prognostic nomogram was generated. And the model was validated using the bootstrap method.

CONCLUSION

Inflammation and nutrition indicators are associated with the prognosis of AGC patients undergoing gastrectomy and prophylactic HIPEC. The nomogram based on the INPI and clinical features supports personalized treatment strategies improving prognosis for AGC patients undergoing gastrectomy and prophylactic HIPEC.

Keywords: Gastric cancer; Inflammation; Nutrition; Hyperthermic intraperitoneal chemotherapy; Nomogram; Prognosis

Core Tip: This study introduces a novel inflammatory nutritional prognostic index (INPI) for advanced gastric cancer (AGC) patients undergoing gastrectomy and prophylactic hyperthermic intraperitoneal chemotherapy. Analyzing data from 181 patients, we established the INPI to stratify patients into three distinct risk groups, revealing significant prognostic differences. Our prognostic nomogram, integrating INPI with clinical features, demonstrated superior predictive performance compared to traditional tumor-node-metastasis staging, offering a valuable tool for personalizing treatment strategies and improving patient outcomes in AGC management.