The Impact of the Prognostic Nutritional Index and Systemic Inflammatory Indices on Survival in Patients Receiving Neoadjuvant FLOT Chemotherapy for Gastric and Gastroesophageal Junction Adenocarcinoma
Nazan Demir11Department of Medical Oncology, Koç University Hospital, İstanbul, Türkiye
Objectives: Neoadjuvant/perioperative FLOT chemotherapy is standard of care in locally advanced gastric/GEJ adenocarcinoma, yet survival varies among similarly treated patients. We evaluated PNI and systemic inflammatory indices as predictors of overall survival (OS) and progression-free survival (PFS). Methods: We retrospectively reviewed 196 patients with gastric/GEJ adenocarcinoma who received neoadjuvant FLOT (2016–2025) at Koç University Hospital. PNI and ten inflammatory markers were calculated from pretreatment blood tests and tested against OS/PFS using Cox regression, with Benjamini–Hochberg FDR correction for multiple comparisons. Results: Median age was 62 years; median follow-up was 30.9 months. Fifty-two patients (26.5%) died; median OS was 86.4 months, median PFS was 53.6 months, and the pCR rate was 28.3%. None of the inflammatory indices was associated with OS or PFS after FDR correction. PNI<45 was associated with significantly shorter OS (HR 3.39; 95% CI 1.55–7.40; p=0.002; FDR q=0.047), which persisted on multivariable analysis (HR 3.75; 95% CI 1.53–9.19; p=0.004). The PFS association was directionally consistent but of borderline significance (HR 1.90; p=0.070). Conclusion: None of the inflammatory indices was prognostic. Only PNI<45 was independently associated with shorter OS; given the low-PNI group’s small size (n=17), this finding is hypothesis-generating and requires prospective validation. Keywords: FLOT, gastric cancer, inflammatory markers, neoadjuvant therapy, prognostic nutritional index, survival
Cite This Article
Demir N. The Impact of the Prognostic Nutritional Index and Systemic Inflammatory Indices on Survival in Patients Receiving Neoadjuvant FLOT Chemotherapy for Gastric and Gastroesophageal Junction Adenocarcinoma. EJMI. 2026; 10(4): 610-617
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