Xiaofeng Zhao,1 Fen Zhang,2 Panpan Xing,3 Chunyan Jiang,4 Danqing Li,2 Dianchao Wu1 

1Department of Gastrointestinal Tumor Surgery, Xingtai People’s Hospital, Xingtai, Hebei, 054001, People’s Republic of China; 2Department of Radiotherapy, Xingtai People’s Hospital, Xingtai, Hebei, 054001, People’s Republic of China; 3Department of Digest Internal Medicine, Xingtai People’s Hospital, Xingtai, Hebei, 054001, People’s Republic of China; 4Department of General Surgery, Xingtai People’s Hospital, Xingtai, Hebei, 054001, People’s Republic of China

Correspondence: Dianchao Wu, Department of Gastrointestinal Tumor Surgery, Xingtai People’s Hospital, Xingtai, Hebei, 054001, People’s Republic of China, Email sunny_zxf@163.com

Objective: This study aimed to investigate whether Gustave Roussy immune score (GRImScore) serves as a novel prognostic index for predicting survival in patients with advanced gastric cancer.
Methods: GRImScore was based on three objective markers: (1) albumin level (< 3.5 g/L = 1 point, ≥ 3.5 g/L = 0 point); (2) lactate dehydrogenase level (≥ 250 U/L = 1 point, < 250 U/L = 0 point); (3) neutrophil to lymphocyte ratio (NLR) (≥ 2.70 = 1 point, < 2.70 = 0 point). According to GRImScore, these patients were divided into low GRImScore group (0 points) and high GRImScore group (1, 2, or 3 points). Kaplan–Meier method was applied to draw survival curves for disease free survival (DFS) and overall survival (OS), and differences among these groups were analyzed using Log rank tests. Univariate and multivariate Cox proportional hazards models were used to analyze the relationship between the enrolled parameters and OS. Nomograms were developed based on the results of multivariate Cox regression analysis using the consistency index (C-index) and decision curve analyses (DCA) for internal validation.
Results: Based on GRImScore, 134 patients were in low GRImScore group and 61 were in high GRImScore group. The median DFS and OS in low GRImScore group were significantly longer than that in high GRImScore group (DFS: 40.52 months vs 22.83 months, χ2=7.033, P=0.0080; OS: 55.07 months vs 31.83 months, χ2=6.328, P=0.0119). According to multivariable Cox analysis, GRImScore was significantly associated with DFS (HR, 2.798; 95% CI: 1.711– 11.008, P = 0.001) and OS (HR, 2.631; 95% CI: 1.645– 10.725, P = 0.001). The nomogram constructed by multivariate Cox analysis showed good performance in predicting DFS (C-index: 0.717, 95% CI: 0.595– 0.814) and OS (C-index: 0.725, 95% CI: 0.605– 0.819).
Conclusion: GRImScore, a novel prognostic index, is a prognostic indicator for patients with advanced gastric cancer. Nomograms based on the GRImScore showed good predictive ability.

Keywords: advanced gastric cancer, Gustave Roussy immune score, GRImScore, albumin, neutrophil to lymphocyte ratio