The interactions between geriatric nutritional risk index and systemic immune-inflammation index for post-recurrence prognosis in patients with pancreatic cancer: a retrospective study

BACKGROUND: Nutritional status and systemic immune-inflammatory activity reflect dynamic interactions between tumor biology and host response and are closely implicated in cancer progression. However, the comparative prognostic utility of nutritional and immune-inflammatory indices in the post-recurrence setting of pancreatic cancer remains unclear. This study investigated the prognostic interaction between established nutritional and immune-inflammatory markers in patients with recurrent pancreatic cancer following pancreatectomy. METHODS: A total of 120 patients who developed recurrence following pancreatectomy for pancreatic cancer were retrospectively analyzed. Nutritional status was assessed using serum albumin, the geriatric nutritional risk index (GNRI), and the prognostic nutritional index (PNI). Immune-inflammatory status was evaluated using the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). The prognostic significance of these indices for post-recurrence survival was examined, and their discriminative performance was compared. RESULTS: Among the nutritional markers, the GNRI demonstrated the highest discriminative ability for post-recurrence survival, while the SII showed the strongest performance among immune-inflammatory indicators. Both GNRI and SII were significantly associated with survival after recurrence. Stratification based on the combined GNRI and SII classification revealed that the integrated model provided superior prognostic discrimination compared with either marker alone. Multivariate analysis confirmed that the combined GNRI–SII classification was an independent prognostic factor in patients with recurrent pancreatic cancer (p = 0.005). CONCLUSIONS: Patients presenting with a low GNRI and high SII at the time of recurrence experienced significantly poorer survival compared with other combinatorial groups. The combined assessment of GNRI and SII represents a practical and potentially valuable tool for prognostic stratification and may assist in guiding optimal therapeutic decision-making in recurrent pancreatic cancer.