Prognostic Value of the Gustave Roussy Immune Score in Patients with Locally Advanced Gastric Cancer Receiving...

Background: Gastric cancer remains a leading cause of cancer mortality, and additional prognostic tools reflecting host inflammation and nutritional status are needed, particularly in patients receiving neoadjuvant regimens such as fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT). This study aimed to evaluate the prognostic significance of the Gustave Roussy Immune (GRIm) score in patients with locally advanced gastric cancer treated with neoadjuvant FLOT. Methods: This retrospective single-center study included 128 patients with locally advanced gastric or gastroesophageal junction (GEJ) adenocarcinoma treated with neoadjuvant FLOT between 2018 and 2022. The GRIm score, based on albumin, lactate dehydrogenase (LDH), and neutrophil-to-lymphocyte ratio (NLR), was used to stratify patients into low- and high-risk groups. Overall survival (OS) and progression-free survival (PFS) were analyzed using Kaplan-Meier and Cox proportional hazards regression models. Results: Among 128 patients (mean age, 61.5 years; 63.3% male), 69.5% underwent surgical resection, and 24.7% achieved a pathological complete response. During a median follow-up of 36.9 months, 57.0% of patients experienced disease progression and 48.4% died. The median OS and PFS were 49.9 and 25.5 months, respectively. The GRIm score demonstrated moderate discriminative ability for mortality (area under the curve [AUC]: 0.704) and was significantly associated with survival. The median OS was shorter in the high-risk group than in the low-risk group (35.2 vs. 69.6 months, p < 0.001), and the median PFS was also shorter in the high-risk group (17.2 months vs. not reached, p < 0.001). In the multivariate analysis, high GRIm risk remained independently associated with worse OS (hazard ratio [HR]: 1.832, p = 0.030) and PFS (HR: 2.491, p < 0.001), along with age, clinical stage, and surgical resection status. Conclusions: In this single-center retrospective cohort study, the GRIm score was associated with survival outcomes in patients with locally advanced gastric or GEJ adenocarcinoma receiving neoadjuvant FLOT. These findings suggest that the GRIm score may provide additional risk stratification when interpreted in conjunction with established clinical factors. However, external validation in larger prospective cohorts is required before it can be applied in routine clinical practice.