Prognostic Significance of Platelet-Lymphocyte Ratio (PLR) and Prognostic Nutritional Index (PNI) in Remnant Gastric Cancer: A Multicenter Retrospective Study.

Background: Remnant gastric cancer (RGC) is known to have a poorer prognosis compared to primary gastric cancer. Inflammation-based prognostic scores (IBPSs), which reflect systemic inflammation and nutritional status, have recently emerged as useful prognostic markers in various malignancies. However, their significance in RGC remains unclear due to the rarity of the disease and the limited number of cases available at single institutions.

Methods: We conducted a retrospective multicenter study of 135 patients who underwent surgery for RGC between 2013 and 2024 at Kyushu University and four affiliated hospitals. After excluding nine patients with synchronous malignancies or noncurative resections, 126 patients were included in the final analysis. Associations between IBPSs-including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein-to-albumin ratio (CAR), and prognostic nutritional index (PNI)-and both short- and long-term outcomes were evaluated.

Results: Receiver operating characteristic (ROC) analysis determined optimal cutoff values for each IBPS. Kaplan-Meier analysis revealed that PLR ≥ 195 and PNI < 43.5 were significantly associated with poorer overall survival (OS) (P = 0.008 and P < 0.001, respectively). Multivariate analysis identified PLR ≥ 195 and PNI < 43.5 as independent predictors of poor OS and recurrence-free survival (RFS). Additionally, PLR ≥ 260 was identified as an independent risk factor for postoperative complications (P = 0.047).

Conclusion: PLR and PNI are independent prognostic markers for both OS and RFS in patients undergoing curative surgery for RGC. Elevated PLR also predicts postoperative complications, highlighting its potential role in perioperative risk stratification.