Postoperative Glucose-Lymphocyte Ratio and Visceral Fat Predict Gastric Cancer Survival

Two simple measurements taken around surgery for gastric cancer—one drawn from a routine blood test and one from preoperative imaging—may help judge a patient's long-term outlook more accurately than tumor staging alone, according to a retrospective cohort study published in Frontiers in Nutrition. In a group of 339 patients without diabetes, a high glucose-to-lymphocyte ratio on the first day after surgery and a low visceral adipose tissue index before surgery were each independently associated with poorer overall survival. The study addressed a recognized limitation in gastric cancer care.

TNM staging, the standard framework for describing how far a tumor has spread, has limited utility for individualized risk stratification: two patients with the same stage can follow different clinical courses. The researchers therefore evaluated whether two additional markers—preoperative body composition and the postoperative metabolic-immune response captured by the glucose-to-lymphocyte ratio—could add prognostic information beyond stage. The first marker, the visceral adipose tissue index (VATI), quantifies the amount of fat stored around the abdominal organs, measured before any operation.

The second marker, the glucose-to-lymphocyte ratio (GLR), combines a metabolic reading—blood glucose—with an immune one—circulating lymphocyte count—captured on postoperative day 1. The cohort comprised 339 non-diabetic patients with gastric cancer, randomly divided into a training set of 272 patients and an internal validation set of 67. The researchers used Cox regression to identify factors associated with overall survival, then applied causal mediation analysis: they tested whether the postoperative GLR statistically explained—mediated—the link between preoperative visceral fat and survival, using a linear mediator model paired with a parametric accelerated failure-time model.

The regression results were consistent across markers. Neoadjuvant chemotherapy, advanced pathological TNM stage, a high postoperative day 1 GLR, and a low preoperative VATI were each independently associated with poorer overall survival, with P values below 0.05. In other words, patients who entered surgery with less visceral fat and who had a higher glucose-to-lymphocyte ratio in the immediate aftermath of the operation tended to fare worse over follow-up.

The mediation analysis, however, returned a null result. The average causal mediation effect of GLR on the VATI–survival association was estimated at −3.82 days, with a 95% confidence interval spanning −189.75 to 105.37 days and a P value of 0.899—far from statistical significance. Sensitivity analyses produced similar findings.

This means the data provided no statistically significant evidence that the postoperative glucose-lymphocyte ratio acts as the pathway through which low visceral fat is associated with survival; the two markers appear to carry independent prognostic information rather than one operating through the other. Building on these results, the team constructed the TGV nomogram, integrating four variables: pathological TNM stage, receipt of neoadjuvant chemotherapy, postoperative day 1 GLR, and preoperative VATI. Internal validation suggested the model performed well.

In the training cohort, the TGV model achieved area under the curve values of 0.850 at three years and 0.798 at five years, compared with 0.769 and 0.702 for pathological TNM stage alone. In the internal validation cohort, the corresponding TGV figures were 0.785 and 0.729, against 0.782 and 0.642 for stage alone. Time-dependent receiver operating characteristic analysis, calibration assessment, and decision curve analysis were used to verify these estimates; the decision curve analysis in the training cohort indicated a higher net benefit for the TGV model than for stage alone across much of the evaluated threshold probability range at both time points.

The authors were careful to frame the findings as preliminary. The retrospective design also means the associations, while statistically robust, do not establish that modifying glucose, lymphocytes, or visceral fat would change outcomes. Even so, the study offers a template for individualized prognosis in gastric cancer.

It shows that a metabolic-immune ratio measured within 24 hours of surgery and a body-composition index measured before it each add signal beyond tumor stage, that these signals do not appear to operate through a single shared pathway, and that combining them with staging into a nomogram improved discrimination—particularly at the five-year horizon, where stage alone performed weakest in validation. Whether that advantage holds in external cohorts is the question future validation studies must answer.

Subject of Research: Prognostic value of postoperative glucose-to-lymphocyte ratio and visceral adipose tissue index in non-diabetic gastric cancer patients

Article Title: Prognostic value of postoperative glucose-to-lymphocyte ratio and visceral fat index in non-diabetic gastric cancer patients: a mediation and modeling study

Article References: Lai, M., Lan, N., Zhou, Y., & Yuan, W. (2026). Prognostic value of postoperative glucose-to-lymphocyte ratio and visceral fat index in non-diabetic gastric cancer patients: a mediation and modeling study. Frontiers in Nutrition, 13, Article 1838308. https://doi.org/10.3389/fnut.2026.1838308

Image Credits: AI Generated

DOI: 10.3389/fnut.2026.1838308

Keywords: gastric cancer, glucose-to-lymphocyte ratio, visceral adipose tissue index, overall survival, nomogram, TNM staging, mediation analysis, retrospective cohort, postoperative prognosis, clinical nutrition, Prognostic, value