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Development and prognostic evaluation of a combined SII–LNR score in resectable gastric and gastroesophageal junction adenocarcinoma treated with perioperative FLOT

gastroenterology-and-hepatology
oncology
surgery-and-surgical-specialties

Abstract

Background: The systemic immune-inflammation index (SII) and lymph node ratio (LNR) have both been associated with survival in gastric and gastroesophageal junction (GEJ) adenocarcinoma, but their combined prognostic value is unclear in patients treated with perioperative fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT). We developed a combined SII–LNR risk score and assessed its association with overall survival (OS) and disease-free survival (DFS).

Methods: This retrospective single-center cohort included 153 patients with resectable gastric or GEJ adenocarcinoma treated with perioperative FLOT. SII was calculated from pretreatment complete blood counts and LNR from postoperative pathology. OS and DFS were evaluated using Kaplan–Meier methods and Cox proportional hazards regression. Cut-offs were defined using receiver operating characteristic (ROC) analysis with the Youden index, and area under the curve (AUC) values were reported.

Results: ROC-derived cut-offs were 715 for SII (AUC 0.602) and 0.13 for LNR (AUC 0.751). The combined SII–LNR score categorized patients into low (34.0%), moderate (43.8%), and high-risk (22.2%) groups. Median OS was 41.5, 30.5, and 17.2 months, with 5-year OS rates of 40.5%, 17.1%, and 4.4%. Median DFS was 2.7, 1.3, and 0.9 years, with 5-year DFS rates of 34.2%, 17.4%, and 5.7%. Compared with the low-risk group, the risk of death was higher in the moderate- and high-risk groups (HR 1.93, 95% CI 1.15–3.26; HR 4.13, 95% CI 2.37–7.22) and the risk of a recurrence was also higher (HR 2.07, 95% CI 1.25–3.42; HR 3.58, 95% CI 2.12–6.02). In multivariable analysis for OS, tumor location and LNR remained independent prognostic factors.

Discussion: The combined SII–LNR score stratified patients into distinct OS and DFS risk groups among patients treated with perioperative FLOT. If confirmed in multicenter cohorts, it may help identify patients who warrant closer follow-up.

Keywords: Gastric Adenocarcinoma; Overall Survival; Disease-Free Survival; Lymph Node Ratio; Systemic Immune-Inflammation Index
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