Results from a retrospective study revealed that Onodera’s prognostic nutritional index (OPNI) is an independent predictor of relapse-free survival (RFS) in patients with gastrointestinal stromal tumors (GISTs) treated with or without tyrosine kinase inhibitors (TKIs).

Higher OPNI as well as immunoinflammatory factors, including lower neutrophil-to-lymphocyte ratio (NLR) and lower platelet-to-lymphocyte ratio (PLR), had statistically significant correlations with improved RFS rates.

Other factors that showed positive correlations with RFS rates included tumor size (log-rank P =.002), mitotic index (log-rank P =.001), modified NIH risk stratification (log-rank P < .001), primary tumor location (log-rank P =.007), and patient age (log-rank P =.023). This study confirmed statistically significant, negative prognostic correlations between high mitotic index (P =.002), high NLR (P =.031), low OPNI (P =.009), large tumor size (P =.003), and patient age over 60 (P =.008).

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Higher OPNI correlated with a GIST location in the stomach, smaller tumor size, lower mitotic index, lower risk categorization using the NIH risk classification, decreased bleeding rate, decreased likelihood of tumor rupture, and significantly lower relapse rate. Analysis showed a strong association between neutrophil-to-lymphocyte ratio (NLR) and tumor location, gastrointestinal bleeding, tumor rupture, and relapse. Lastly, the platelet-to-lymphocyte ratio (PLR) correlated with tumor site, GI bleeding, and probability of relapse.

Study Methods and Limitations

The authors retrospectively obtained data from 563 patients with intermediate and high-risk GISTs, including 349 patients who did not receive TKI therapy and 214 who did. After selection using specific inclusion criteria, only 280 patients were enrolled in this study, with 178 of them receiving imatinib and 102 receiving no TKI therapy following R0 surgery to remove their GISTs.

Preoperative tests included bloodwork and blood biochemistry within 5 days prior to surgery. These tests included the NLR, PLR, and OPNI. The investigators calculated OPNI as serum albumin + 5x the total lymphocyte count.

Following resection of the GISTs, laboratory pathologists determined each GIST’s risk stratification using the modified NIH consensus criteria using tumor size, mitotic index, location of the primary tumor, and tumor rupture (preoperative or during operation). Pathologists determined GIST type using immunohistochemistry and histopathological assessments.

Clinicians followed these patients for 5 years with routine evaluations every 6 months to detect GIST recurrence or metastasis. Researchers calculated RFS rates from the date of surgery to the date of GIST relapse, metastasis, or the patient’s final follow-up.

One limitation of this research was the use of a single-center retrospective study instead of a multicenter approach. Another limitation included the determination of the best cut-off value using survival cut-off analysis. Other limitations included a small patient sample size and a lack of uniformity, with only some patients receiving gene testing, which prompted the inability to consider of type of mutation impacting results in this study.


Wang F, Tao T, Yu H, et al. Prognostic value of Onodera’s nutritional index for intermediate- and high-risk gastrointestinal stromal tumors treated with or without tyrosine kinase inhibitors. World J Surg Onc. 2021;19:227. doi:10.1186/s12957-021-02345-9