Preoperative total cholesterol-lymphocyte score as a novel immunonutritional predictor of survival in gastric cancer.

Abstract

Immunonutritional status is a known prognostic correlate in the context of gastric cancer (GC). In the present study, we investigated the prognostic relevance of a lipid profile-based immunonutritional score in patients with GC. Data pertaining to 224 patients with stage II and III GC who underwent curative gastrectomy were retrospectively analyzed. The total cholesterol-lymphocyte score (TL score) was defined as follows: patients with both low total cholesterol (TC) and total lymphocyte count were allocated a score of 2; patients with only one or none of these biochemical abnormalities were allocated a score of 1 or 0, respectively. Among the serum lipid indices, low TC was the strongest predictor of cancer-specific survival (CSS; p= 0.001). On multivariate analysis, both low prognostic nutritional index (PNI) (p< 0.001) and high TL score (p= 0.003) were independent prognostic factors. PNI was significantly associated with peritoneal recurrence (p= 0.047), while TL score was significantly associated with locoregional and distant metastasis (p= 0.004 and p= 0.003, respectively). TL score may facilitate risk stratification of patients based on CSS. TL score plus PNI may help predict the recurrence pattern in patients with stage II and III GC.