Prognostic nomogram for overall survival in resectable gastric cancer: incorporating prognostic nutritional index and fibrinogen.

Introduction:Few studies have investigated the combined prognostic value of the prognostic nutritional index (PNI) and plasma fibrinogen (FIB) in predicting long-term survival in patients undergoing radical gastrectomy for gastric cancer. Objectives: This study aimed to examine the association between preoperative PNI, FIB, and overall survival (OS) in patients undergoing radical gastrectomy, and to develop a prognostic nomogram for predicting postoperative OS in gastric cancer (GC) patients. Methods: This retrospective study included 395 patients who underwent radical gastrectomy. Univariate and multivariate Cox proportional hazards regressions were used to identify independent prognostic factors and develop a nomogram for predicting overall survival (OS). The nomogram's accuracy and discriminatory performance were evaluated using the Receiver Operating Characteristic (ROC) curve, concordance index (C-index), and calibration curve. Decision curve analysis (DCA) was also applied to assess its clinical utility. Results: The findings from the multivariate COX regression analysis revealed that preoperative PNI, plasma FIB, nerve invasion, and pathological TNM stage were identified as independent predictive variables for postoperative OS in patients who underwent radical gastrectomy (P<0.05). Patients with high PNI (PNI>49.3) and low FIB (FIB<3.6) had a substantially greater OS. The nomogram, developed from independent prognostic factors, exhibited a C-index of 0.782, surpassing the predictive accuracy of pathological TNM staging alone (C-index = 0.719) in predicting overall survival (OS). Conclusions: The prognostic nomogram incorporating PNI and FIB is a reliable tool for forecasting postoperative survival in GC patients and aiding surgeons in devising individualized treatment strategies.