Integrative Cancer Therapies · Published 2026-07-01 · DOI 10.1177/15347354261447851
Chun Gao, Li Zhu, Yi Xin Tong, Sheng Zhang
Background: To develop and validate a clinically applicable nomogram (NUTRISCORE) predicting severe neutropenia (Grade 3/4) across cycles 2 to 8 of adjuvant chemotherapy in gastric cancer. Methods: This retrospective cohort study analyzed 391 patients receiving postoperative adjuvant chemotherapy (CAPEOX/XELOX/SOX) following curative laparoscopic D2 gastrectomy. Cohorts were stratified into derivation (n = 318; 1518 cycles) and validation (n = 73; 356 cycles) sets. Generalized Estimating Equations (GEE) were used to account for within-patient correlation of multiple cycles. Multivariable logistic regression identified independent predictors, with subsequent nomogram construction using R. Model performance was quantified through AUC-ROC and decision curve analysis (DCA). Results: Four predictors emerged: age > 60 years (OR = 2.1, P < .01), prealbumin ≤ 180 mg/L (OR = 3.4, P = .002), PNI < 45 (OR = 2.8, P = .008), and prior cycle neutropenia (OR =4.7, P < .001). The nomogram achieved AUCs of 0.825 (95% CI 0.789-0.860) and 0.810 (0.783-0.835) in derivation and validation cohorts, with DCA confirming clinical utility across threshold probabilities (4%-65% in derivation, 3%-63% in validation), supporting its use for guiding G-CSF prophylaxis at clinically relevant risk thresholds (>15%). Conclusions: We establish a nutrition-centric predictive tool for severe neutropenia, demonstrating robust accuracy in stratifying chemotherapy toxicity risk. This model directly informs personalized prophylactic strategies, warranting prospective multicenter validation.
Abstract from DOAJ. Public domain (CC0 1.0).
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Gao, C., Zhu, L., Tong, Y., et al. (2026). NUTRISCORE: A Novel Nutrition-Based Nomogram to Predict Severe Neutropenia After Adjuvant Chemotherapy in Gastric Cancer. Integrative Cancer Therapies. https://doi.org/10.1177/15347354261447851