Fat-Free Mass Index Combined with Neutrophil–Lymphocyte Ratio as a Promising Marker for Predicting Oncological Outcomes in Gastric Cancer: A Large-Sample Study

Abstract Background Malnutrition and inflammation can affect the prognosis of patients with gastric cancer (GC). This study aimed to explore the value of fat-free mass index (FFMI) combined with the neutrophil–lymphocyte ratio (NLR) on the short- and long-term outcomes of patients with GC. Methods We retrospectively analyzed 1603 patients with GC in at a tertiary referral teaching hospital between 2016 and 2019. Patients in the 1st quartile of FFMI were defined as the low FFMI group and the remaining patients as the normal FFMI group, according to sex-specific quartiles. Patients were divided into high and low NLR groups according to the median NLR. Patients with a low FFMI/high NLR were defined as the high-risk group, and the remaining patients were defined as the low-risk group. Results The postoperative recovery time of the high-risk group was significantly longer than that of the low-risk group (all P <0.05). Logistic regression analysis indicated that FNC could independently predict postoperative anastomotic leakage (OR=2.16, 95% CI: 1.03–4.54, P=0.041). The high-risk group had much worse 3-y overall survival (64.7% vs. 79.4%; P<0.001) and 3-y disease-free survival (62.8% vs. 78.6%; P<0.001) than the low-risk group. Multivariate Cox analysis showed that FNC was an independent prognostic factor for patients with GC (HR=1.54, 95% CI: 1.22–1.94, P<0.001). Further stratified analysis based on tumor stage showed that the high-risk group did not benefit from postoperative adjuvant chemotherapy. Conclusions FFMI combined with NLR can predict postoperative short- and long-term outcomes in patients with GC.