Nutritional-C-reactive protein ratio as a prognostic marker in gastric cancer: a multicenter study

This study aimed to investigate the association of baseline Nutritional-C-reactive Protein Ratio (NCR) with overall survival (OS), severe malnutrition, and cachexia in patients with gastric cancer.

Baseline NCR was calculated as BMI (kg/m²) × albumin (g/L) / C-reactive protein (mg/L) using measurements obtained at study enrollment and original continuous CRP values. The ROC-derived cutoff was used to classify patients into low- and high-NCR groups. Kaplan-Meier curves and log-rank tests were used to compare OS. Cox proportional hazards models assessed the association between NCR and OS, while logistic regression evaluated associations with severe malnutrition and cachexia.

A total of 1,058 patients with pathologically confirmed gastric cancer were included. The exploratory ROC-derived cutoff value for NCR was 178. Patients with high NCR had significantly better OS than those with low NCR (65.3% vs. 48.4%, log-rank p < 0.001). In multivariable Cox regression, high NCR was independently associated with better OS (HR = 0.598, 95% CI: 0.478-0.747, p < 0.001), with a significant dose-response relationship across NCR quartiles (p for trend < 0.001). Logistic regression showed that high NCR was associated with lower odds of severe malnutrition (OR = 0.390, 95% CI: 0.300-0.505, p < 0.001) and cachexia (OR = 0.182, 95% CI: 0.137-0.242, p < 0.001).

Baseline NCR is a simple and clinically accessible composite biomarker integrating nutritional and inflammatory status. It may serve as a complementary marker for risk stratification in patients with gastric cancer.