Prognostic Value of the Nutritional Risk Index and Hemoglobin-to-Platelet Ratio Score for Predicting Recurrence and Survival in Siewert II/III Gastroesophageal Junction Adenocarcinoma.

BACKGROUND

Postoperative recurrence remains common in patients with Siewert type II/III gastroesophageal junction adenocarcinoma (AEG), and conventional TNM staging provides limited individualized prognostic information. This study aimed to develop and validate a composite Nutritional Risk Index and Hemoglobin-to-Platelet Ratio (NRI-HPR) score for predicting recurrence and survival.

METHODS

A total of 270 patients who underwent curative gastrectomy between 2011 and 2015 were included as the training cohort, and 117 patients treated between 2020 and 2023 were enrolled as an independent validation cohort. Patients were stratified into three NRI-HPR score groups according to predefined cutoffs. Survival outcomes and recurrence patterns were analyzed using Kaplan–Meier and Cox regression analyses. Prognostic nomograms incorporating NRI-HPR were constructed and validated.

RESULTS

In the training cohort, 5-year recurrence-free survival (RFS) rates were 79.6%, 60.3%, and 37.4% for NRI-HPR scores 0, 1, and 2, respectively (P < 0.001). Patients with score 2 exhibited a significantly higher recurrence rate than those with scores 0–1 (69.8% vs. 31.3%, P < 0.05), particularly for locoregional recurrence and distant metastasis. The NRI-HPR score also significantly stratified RFS and overall survival (OS) in the validation cohort (both P < 0.001). Nomograms incorporating NRI-HPR demonstrated superior predictive performance compared with TNM staging alone for both RFS and OS, with good calibration.

CONCLUSIONS

The NRI-HPR score is a practical biomarker for predicting recurrence and survival in Siewert II/III AEG and improves prognostic stratification beyond conventional staging.