2119P The prognostic impact of nutritional assessment and scores in advanced gastric cancer

Malnutrition and weight loss have renowned prognostic value in patients (pts) with localised gastric cancer (GC). We analysed the association of weight loss and early nutritional intervention with outcomes in pts with advanced GC. A retrospective cohort of non-resected metastatic GC pts treated with first-line chemotherapy (CT) at the Academic Hospital of Udine (2012-2022) was analysed. Biometric and nutritional parameters were evaluated at diagnosis and during treatment. The prognostic value of >10% weight loss 3 months (mo) after nutritional intervention was assessed. Nutritional interventions and scores (Prognostic Nutritional Index [PNI], neutrophil-lymphocyte ratio [NLR], platelet-lymphocyte ratio [PLR]), dichotomized as high/low per literature-derived cut-offs, were evaluated as predictors of overall survival (OS) and progression-free survival (PFS) with Cox regression model. 100 pts were included (65 male), median age was 69 years. At CT start, 87.8% of pts had lost weight (>10% in 49.4%), with a median loss of 8 Kg. 55.7% of pts had low PNI, more than 60% high NLR and PLR. 71 pts underwent nutritional assessment (NA), 53.5% before CT start; median time from diagnosis to NA was 40 days. 51 pts had >1 NA, 31 pts >2 NA. At first NA, nutritional interventions consisted in oral supplements (53.4%), parenteral nutrition (28.2%) and counselling (59.2%). Overall, 49% of pts gained weight 3 mo after NA; 88.9% of pts’ PNI improved, >50% of NLR and PLR lowered. At disease progression, recorded in 96 pts, PLR and NLR increased significantly (60% vs 48% at 3 mo after NA and 70% vs 34%, respectively). In our cohort, median PFS was 5 mo and median OS was 9 mo. Low PNI (HR 2.05, p = 0.008), high NLR (HR 2.51, p <0.001) and PLR (HR 2.63, p <0.001) at CT start and a >10% weight loss (HR 3.05, p = 0.020) 3 mo after first NA were associated with worse OS. PLR improvement at 3 mo after first NA was associated with better OS (HR 0.46, p = 0.018). These results underline the importance of early and efficient nutritional assessment and support in cancer pts. The prognostic value of PNI, NLR and PLR reinforces the importance of the interplay between immune system and weight loss for advanced GC.