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Journals / Akdeniz Tıp Dergisi / 2026 / Cilt: 12 Sayı: 1

Predictive Value of Delta-PNI on Major Pathological Response in Gastric Cancer Patients Treated With Neoadjuvant FLOT Regimen

Neoadjuvan FLOT Rejimi ile Tedavi Edilen Mide Kanseri Tanılı Hastalarda Delta-PNI Değerinin Majör Patolojik Yanıt Üzerine Prediktif Etkisi

Halil Göksel Güzel(Health Sciences University, Antalya Training and Research Hospital, Department of Medical Oncology)0000-0001-8310-1752
Banu Öztürk(Health Sciences University, Antalya Training and Research Hospital, Department of Medical Oncology)0000-0003-0290-8787
Pages
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Publication Date
2026-03-04
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Future studies with larger cohorts are needed to highlight this topic.

📌 3 Key Takeaways

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Objective & Hypothesis:Objective: We aimed to investigate the predictive effect of prognostic nutritional index change (Delta-PNI) from initiation to completion of the neoadjuvant fluorouracil-oxaliplatin-docetaxel (FLOT) regimen on the major pathological response (mPR) in patients with non-metastatic gastric cancer.
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Key Findings & Data:Material and Methods: A single-center, retrospective study was conducted, screening the patients treated at Antalya Training and Research Hospital between 2019 and 2024.
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Conclusion & Impact:Future studies with larger cohorts are needed to highlight this topic.
🔬Design:Klinik Araştırma
📍Scope:2019 Verileri
⚙️Variables:Mide kanseri · Prognostik beslenme indeksi · Neoadjuvan tedavi

Abstract

Objective: We aimed to investigate the predictive effect of prognostic nutritional index change (Delta-PNI) from initiation to completion of the neoadjuvant fluorouracil-oxaliplatin-docetaxel (FLOT) regimen on the major pathological response (mPR) in patients with non-metastatic gastric cancer. Material and Methods: A single-center, retrospective study was conducted, screening the patients treated at Antalya Training and Research Hospital between 2019 and 2024. The difference between the PNI values prior to the initiation of FLOT and after the completion of four cycles of FLOT was calculated as Delta-PNI. The patients were dichotomised by the median of Delta-PNI value 5.4 (15,55 - 19,70). Results: A total of 41 patients were included (n=41). The median age was 63 years (40-79) and nine patients (22%) were female. Thirteen patients (31.7%) had mPR, while five patients (12.1%) had tumor progression after neoadjuvant chemotherapy. In the univariate analysis, the high delta-PNI value (≥5.4) and low delta-PNI (<5.4) groups had similar rates of mPR [35.0% vs. 28.6%, respectively; p=0.744)]. In the multivariate analysis, the odds ratio for having mPR was 0.99, 95% CI (0.18-5.40) for patients with a higher delta-PNI value compared to those with a lower delta-PNI value (p=0.994). The other variables were also not significant: pretreatment PNI (p=0.412), sex (p=0.068), histological differentiation (p=0.248), clinical T stage (p=0.999), and N stage (p=0.256). Conclusion: The delta-PNI was not a significant predictor of mPR. This study is the first to evaluate dynamic changes in PNI values in the literature. Future studies with larger cohorts are needed to highlight this topic.

Özet

ÖZ Amaç: Bu çalışmada, neoadjuvan florourasil-oksaliplatin-dosetaksel (FLOT) rejiminin başlanması ile tamamlanması arasındaki prognostik nutrisyon indeks farkının (Delta-PNI), metastatik olmayan mide kanseri hastalarında majör patolojik yanıt (mPR) üzerindeki öngörücü etkisini araştırmayı amaçladık. Gereç ve Yöntemler: Bu çalışma, 2019-2024 yılları arasında Antalya Eğitim ve Araştırma Hastanesi'nde tedavi edilen hastaların tarandığı, tek merkezli, retrospektif bir çalışma olarak gerçekleştirilmiştir. FLOT rejiminin başlangıcından önceki ve dört kürün tamamlanmasından sonraki PNI değerleri arasındaki fark Delta-PNI olarak hesaplanmıştır. Hastalar, Delta-PNI medyan değeri olan 5,4'e (15,55 - 19,70) göre iki gruba ayrılmıştır. Bulgular: Çalışmaya toplam 41 hasta (n=41) dahil edilmiştir. Medyan yaş 63 (40-79) olup, 9 hasta (%22) kadındır. On üç hasta (%31,7) mPR elde ederken, 5 hasta (%12,1) neoadjuvan kemoterapi sonrasında progresyon görülmüştür. Univariate analizlerde, yüksek Delta-PNI değeri (≥5,4) grubuyla düşük Delta-PNI (<5,4) grubunun mPR oranları benzer bulunmuştur [%35,0 vs. %28,6; p=0,744]. Multivariate analizlerde, yüksek Delta-PNI değeri olan hastaların mPR elde etme olasılığı, düşük Delta-PNI değerine sahip hastalara kıyasla 0,99 (%95 CI 0,18-5,40; p=0,994) olarak hesaplanmıştır. Diğer değişkenler de anlamlı bulunmamıştır; tedavi öncesi PNI (p=0,412), cinsiyet (p=0,068), histolojik farklılaşma (p=0,248), klinik T evresi (p=0,999) ve N evresi (p=0,256). Sonuç: Delta-PNI, mPR için anlamlı bir prediktif belirteç olarak bulunmamıştır. Bu çalışma, literatürde PNI dinamik değişimini değerlendiren ilk çalışmadır. Gelecekte daha fazla hasta sayısı ile yapılacak çalışmalar bu konuyu aydınlatabilir.

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Cite This Article

Güzel, H. G., Öztürk, B. (2026). Predictive Value of Delta-PNI on Major Pathological Response in Gastric Cancer Patients Treated With Neoadjuvant FLOT Regimen. Akdeniz Tıp Dergisi, Cilt: 12 Sayı: 1. https://doi.org/10.53394/akd.1618804

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