What if a routine inflammation score could divide patients with metastatic gastric cancer into groups with dramatically different survival? This study tests that possibility using data from 152 patients. Gastric cancer is the fifth most common cancer and the third most common cause of cancer-related death.

That makes finding practical prognostic markers clinically important. Cancer-associated systemic inflammatory response is triggered by the tumor microenvironment and is associated with tumor development, invasion, and metastasis. Systemic inflammatory response is also associated with predisposition to cachexia and deterioration of the patient’s performance.

Some inflammatory biomarkers generated using hematological and biochemical parameters have value in predicting decreased overall or progression-free survival, or resistance to chemotherapy. That is why inflammatory biomarkers have been investigated in a number of tumor types.

C-reactive protein, or CRP, is negatively associated with prognosis, and the neutrophil-to-lymphocyte ratio, or NLR, has been associated with poor prognosis in various cancers. The study aimed to investigate whether inflammatory prognostic index values are associated with progression-free survival and overall survival in patients with stage-four gastric cancer.

Patients diagnosed with metastatic gastric cancer between 2013 and 2020 at Manisa Celal Bayar University Hospital and Private İzmir Kent Hospital were retrospectively analyzed. A total of 152 patients with stage-four gastric cancer whose laboratory parameters, progression-free survival data, and overall survival data could be accessed were evaluated.

Pre-treatment parameters were used so that administered treatments did not affect laboratory and performance results, and the first blood tests were obtained before treatment. Laboratory parameters, performance status, age at diagnosis, sex, and treatments were recorded.

Performance status was evaluated with ECOG performance scoring because it was easier to implement. Categorical variables were presented as patient numbers and percentages, while comparisons used odds ratios and corresponding ninety-five percent confidence intervals with chi-square or Fisher’s exact tests.

Kaplan Meier analysis was used to depict survival curves, and univariate and multivariate analyses used the Cox proportional hazards model to assess survival differences. Only variables significant as prognostic parameters in the univariate Cox proportional hazards model were included in the multivariable analysis to identify independent prognostic factors.

ROC analysis was used to determine the discriminative power of the IPI score and identify a discriminatory cut-off. Table one summarizes demographic and laboratory data for the one hundred fifty-two patients with stage-four gastric cancer. It reports medians alongside minimum–maximum ranges, including age at sixty-three years, CEA at four point two seven five, albumin at three point seven, and hemoglobin at eleven point four.

The broad ranges, such as CEA from zero point one to one thousand seven hundred forty-four and platelet count from thirty-four to one thousand one hundred fifty-seven, show the clinical variability present in this cohort. ROC analysis evaluated the IPI for its predictive value in survival status and identified a cut-off value of fourteen point six.

Low IPI score was significantly associated with longer overall survival and progression-free survival compared with high IPI score. The median overall survival was six point six months in the high-IPI group versus fourteen point two months in the low-IPI group, with a p value below zero point zero zero one.

The median progression-free survival was three point six months in the high-IPI group versus seven months in the low-IPI group, also with a p value below zero point zero zero one. Figure one shows Kaplan–Meier overall-survival curves for patients classified as IPI low or IPI high, with the number at risk listed across months.

The chart reports median overall survival of fourteen point two months versus six point six months, with p less than zero point zero zero one, indicating a statistically significant separation between the groups. This matters because the IPI cutoff identified by ROC analysis distinguishes patients with substantially different survival patterns.

The study also evaluated NLR for its predictive value in survival status and identified a cut-off value of three. Low NLR score was significantly associated with longer overall survival compared with high NLR score, with median overall survival of seven point two months in the high group versus thirteen point six months in the low group.

For progression-free survival, the median was three point five months in the high-NLR group versus six point six months in the low-NLR group, with a p value below zero point zero zero one. Figure two shows progression-free survival curves for the IPI low and IPI high groups over time, with the percentage of patients without progression on the vertical axis and months on the horizontal axis.

The chart reports median progression-free survival of seven months versus three point six months, with a p-value below zero point zero zero one, while the risk table shows how many patients remained under observation at each time point. Table three reports univariate and multivariate hazard ratios for overall survival across prognostic factors.

In the multivariate analysis, IPI, NLR, primary surgery, age, and ECOG status remain statistically significant, while recurrent versus de novo disease has a p value of zero point zero five seven. PLR, chemotherapy regimen, metastatic site count, and sex are not statistically significant in this model, highlighting which factors retain independent associations with survival.

Table four examines progression-free survival using both univariate and multivariable Cox analyses. After adjustment, low IPI versus high had a PFS hazard ratio of zero point fifty-five, with P equal to zero point zero zero four, while low NLR versus high had a hazard ratio of zero point sixty-three, with P equal to zero point zero four.

The authors therefore identify IPI as an independent prognostic index, while noting that these retrospective, relatively small-study findings need confirmation in larger prospective studies. In this analysis of 152 gastric cancer patients, NLR and IPI were associated with survival status, as measured by overall survival and progression-free survival.

The IPI is described as a reproducible, cost-effective, and available prognostic marker for gastric cancer patients. Patients with a high NLR and high IPI score are proposed as a high-risk group in terms of progression and survival. This was a retrospective two-center study with a relatively small number of patients.

The results would therefore be appropriate to confirm with prospective studies involving larger patient participation. As a result of Cox regression analysis, the IPI score could be a parameter that predicts prognosis and survival in patients with metastatic gastric cancer.

The IPI score can be an independent prognostic index that is inexpensive, easy to access, and easy to evaluate for metastatic gastric cancer patients. The study concludes that IPI may be useful in predicting survival in daily clinical practice, while the study limitation leaves confirmation to prospective research with larger patient participation.

In this retrospective study, a low inflammatory prognostic index was associated with longer overall and progression-free survival, and IPI classification was identified as an independent prognostic factor. The result is promising, but larger prospective studies are still needed.