Abstract / Summary
Abstract Background Metastatic and recurrent gastric cancer has heterogeneous clinical outcomes despite advances in systemic therapy. The Gustave Roussy Immune score (GRIm), derived from neutrophil-to-lymphocyte ratio, serum albumin, and lactate dehydrogenase, may provide additional prognostic information. This study evaluated the prognostic value of pretreatment GRIm score in patients with metastatic or recurrent gastric cancer receiving first-line chemotherapy. Methods We retrospectively reviewed patients diagnosed with gastric cancer and treated at the Department of Medical Oncology, SANKO University Faculty of Medicine, between January 2014 and December 2024. Eligible patients were aged 18–80 years, had metastatic disease at diagnosis or developed metastatic recurrence during follow-up, and received first-line chemotherapy. Patients were categorized into low-GRIm (0–1 points) and high-GRIm (2–3 points) groups. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method, and prognostic factors for OS were evaluated using Cox regression analysis. Results A total of 145 patients were included. Seventy-nine patients (54.5%) were classified as low-GRIm and 66 (45.5%) as high-GRIm. Disease control was lower in the high-GRIm group than in the low-GRIm group (50.0% vs. 68.0%, p = 0.037). Median OS was significantly shorter in the high-GRIm group (8.0 vs. 12.0 months, p = 0.001), as was median PFS (3.0 vs. 6.0 months, p = 0.015). In multivariate analysis, high GRIm score remained independently associated with worse OS (HR 1.83, 95% CI 1.29–2.59, p = 0.001), along with peritoneal implant/metastasis, metastatic involvement of ≥ 2 sites, and poor differentiation. Conclusions Pretreatment GRIm may provide a simple means of prognostic risk stratification; further external validation is warranted before routine clinical implementation in metastatic or recurrent gastric cancer.