Preoperative prealbumin levels are prognostic predictors of overall survival, independent of inflammation severity, in patients with gastric cancer following gastrectomy.

[PURPOSE] Coexisting inflammation should be assessed following the diagnosis of malnutrition. This study aimed to determine the effect of low prealbumin levels on the overall survival (OS) of patients with gastric cancer following gastrectomy according to the intensity of inflammation.

[METHODS] This retrospective study included consecutive patients who underwent radical gastrectomy for pStages I-III gastric cancer between 2006 and 2020. Preoperative inflammation severity was classified according to the guidance of the Global Leadership Initiative on Malnutrition criteria as normal (C-reactive protein (CRP) < 0.3 mg/dL), mild (0.3-0.99 mg/dL), moderate (1.0-5.0 mg/dL), or severe (> 5.0 mg/dL). Prealbumin levels were categorized as high (≥ 22 mg/dL), moderate (15-22 mg/dL), or low (< 15 mg/dL).

[RESULTS] Among 5303 patients, 4583 were categorized into the normal group, 483 into the mild CRP group, 204 into the moderate CRP group, and 33 into the severe CRP group. A comparison of OS revealed that low prealbumin levels were associated with poorer OS, regardless of the severity of inflammation. Multivariate analyses confirmed that a low prealbumin level was an independent poor prognostic factor for OS in patients with or without inflammation (P < 0.001 and P < 0.001, respectively).

[CONCLUSIONS] Prealbumin levels can be used as a predictor of OS in patients with gastric cancer after gastrectomy, regardless of preoperative inflammation.