# Immuno-Nutritional Profiling for Survival Stratification in Gastrectomized Patients with Malignant Chronic Intestinal Failure

## TL;DR

This study shows that combining two blood-based scores helps predict survival in cancer patients needing long-term nutrition support after stomach surgery.

## Contribution

The study demonstrates that combining CONUT and LMR improves survival prediction in gastrectomized cancer patients with intestinal failure.

## Key findings

- CONUT and LMR were the only independent predictors of survival in these patients.
- A combined CONUT–LMR model significantly improved prognostic classification compared to single-marker models.
- Kaplan–Meier curves showed clear survival differences across CONUT and LMR strata.

## Abstract

Background/Objectives: Patients who undergo gastrectomy for gastric adenocarcinoma and subsequently develop chronic intestinal failure requiring long-term home parenteral nutrition (HPN) represent a clinically vulnerable cohort in whom survival is shaped by profound nutritional depletion and systemic inflammation. Immuno-nutritional biomarkers may support improved risk stratification in this setting. Methods: This retrospective study included adults who underwent gastrectomy for gastric cancer and developed malignant chronic intestinal failure requiring HPN. Immuno-nutritional status at HPN qualification was evaluated using the Controlling Nutritional Status (CONUT) score and the lymphocyte-to-monocyte ratio (LMR). Overall survival was analysed using Cox proportional hazards models. LMR discrimination was assessed using receiver operating characteristic (ROC) analysis with a Youden-derived cut-off, and differences in AUC were tested using DeLong’s method. Results: Ninety-seven patients met the inclusion criteria. Median overall survival was 176 days. In multivariable analysis, CONUT and LMR were the only independent predictors of survival. Each one-point increase in CONUT was associated with an approximately 70% increase in mortality risk. LMR demonstrated good discriminative ability (AUC 0.795), and a cut-off of 2.083 differentiated survival trajectories. The combined CONUT–LMR model improved prognostic classification, and DeLong’s test confirmed a significant AUC difference compared with single-marker models. Kaplan–Meier curves showed clear separation across CONUT and LMR strata (log-rank p < 0.001). Conclusions: Among patients requiring long-term HPN after gastrectomy for gastric cancer, CONUT and LMR provide complementary prognostic information. Their combined use enhances survival stratification and may support earlier identification of patients with high-risk trajectories.