Development and validation of multiparameter prognostic nomogram combining neutrophil-to-lymphocyte ratio, tumor burden, and nutritional status for predicting postoperative outcome in elderly gastric cancer patients.

[OBJECTIVE] This study aims to construct and verify Nomogram prediction model for clinical outcomes of elderly patients with gastric cancer after surgery, which is based on multiple factors such as peripheral blood neutrophil to lymphocyte ratio (NLR), tumor burden and nutritional status.

[METHODS] A total of 189 elderly patients with gastric cancer who received surgical treatment in our hospital from January 2019 to December 2024 were included in the study. They were divided into a training set (n=132) and a validation set (n=57) according to the ratio of 7:3. The data including age, gender, body mass index (BMI), smoking history, drinking history, comorbidities, tumor location, size, histological type, differentiation degree, TNM stage, lymph node metastasis, and preoperative NLR value were collected. After single-factor and multi-factor analysis, the risk factors influencing the postoperative clinical outcome were screened, and the Nomogram model was constructed, evaluated and validated. The decision curve analysis was used to evaluate the clinical value of the model.

[RESULTS] There were 46 cases (34.85%) with adverse clinical outcomes in the training set and 20 cases (35.09%) with adverse clinical outcomes in the validation set. Multivariate Logistic regression analysis showed that NLR, BMI, tumor size, lymph node metastasis, carcinoembryonic antigen (CEA), and age were the independent influencing factors for adverse clinical outcomes of elderly patients after gastric cancer surgery (all < 0.05). The calibration degree and prediction performance of the nomogram model in the training set and the validation set were good. The C-index index was 0.806 and 0.879, respectively. The calibration curves showed that the average absolute errors of the predicted values and the true values were 0.172 and 0.110, respectively. The Hosmer-Lemeshow test results were χ = 16.669, =0.034 and χ = 5.653, =0.686, respectively. AUC values were 0.802(95% : 0.708-0.895) and 0.888(95% : 0.757-1.000), respectively, with sensitivity and specificity of 0.889, 0.650, and 0.900 and 0.654, respectively.

[CONCLUSION] The NLR-based Nomogram model is useful for predicting the postoperative clinical outcomes of elderly patients with gastric cancer, but it needs to be verified by further large-sample multi-center research.