Pretreatment C‑reactive protein‑triglyceride‑glucose index predicts survival in patients with FLOT‑treated locally advanced gastric and gastroesophageal junction cancer

 The C‑reactive protein‑triglyceride‑glucose index (CTI), integrating C‑reactive protein and the triglyceride‑glucose index, is a pragmatic biomarker reflecting systemic inflammation and metabolic stress in cancer. Although its prognostic value has been validated in heterogeneous cancer cohorts, data in homogeneous perioperative settings remain limited. The present study retrospectively evaluated 131 patients with locally advanced gastric or gastroesophageal junction adenocarcinoma who received perioperative fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) chemotherapy between November 2018 and June 2024 (67 months). CTI was calculated at diagnosis, and patients were stratified using the 4.78 cut‑off value previously validated in oncology populations. Associations between CTI and clinicopathological variables, pathological response, progression‑free survival (PFS) and overall survival (OS) were analyzed. The results demonstrated that among the 131 patients who underwent curative‑intent surgery after neoadjuvant FLOT, 113 (86.3%) had low CTI (<4.78) and 18 (13.7%) had high CTI (≥4.78). Patients with high CTI had significantly shorter PFS compared with those with low CTI (median, 12.2 vs. 25.5 months; P=0.006). OS was also markedly inferior in the high CTI group [median, 23.1 months vs. not reached (NR) in the low CTI group; P=0.001]. In the multivariable analysis, high CTI independently predicted poor PFS [hazard ratio (HR), 2.18; 95% confidence interval (CI), 1.21‑3.95; P=0.010]. Regarding treatment response, the pathological complete response rate was 11.5% (13/113) in the low CTI group and 22.2% (4/18) in the high CTI group (P=0.221), indicating no significant association between CTI and pathological complete response. In conclusion, pretreatment CTI is an independent prognostic marker in patients with locally advanced gastric or gastroesophageal junction adenocarcinoma treated with perioperative FLOT, identifying individuals at higher risk of relapse and inferior survival. The simplicity, low cost and pretherapeutic availability of pretreatment CTI support its use as a promising tool for risk stratification that warrants prospective, multicenter validation.