Integrating Systemic Inflammation and Longitudinal Weight Trajectories Improves Prognostic Stratification in Gastrointestinal Cancers: A Real-World Retrospective Study.

Background/Objectives: This study examined whether the high-sensitivity modified Glasgow Prognostic Score (hs-mGPS) and daily weight change by percentile (DWtCP) are associated with overall survival in patients with gastrointestinal (GI) cancers, overall and across BMI categories. Methods: We analyzed de-identified electronic health record data from 176 patients with GI cancers who had albumin, high-sensitivity C-reactive protein (hs-CRP), and longitudinal weight measurements. hs-mGPS was calculated from baseline albumin and hs-CRP. DWtCP, derived from serial weight measurements, was categorized as weight gain, moderate weight loss, or severe weight loss. Survival was evaluated using Kaplan-Meier and Cox proportional hazards models. Results: Nearly 70% of patients had hs-mGPS = 2, which was associated with poorer survival in the earlier part of follow-up (Breslow p = 0.011; log-rank p = 0.062), a pattern also observed in the high-BMI group (Breslow p = 0.045; log-rank p = 0.059). DWtCP was strongly associated with survival (log-rank p < 0.001; Breslow p < 0.001). Patients with moderate weight loss had the most favorable 1200-day Kaplan-Meier survival estimate (54.6%), compared with 5.1% for severe weight loss and 10.9% for weight gain. In multivariable analysis, moderate weight loss was associated with substantially lower mortality risk than weight gain (HR = 0.194, p < 0.001). In BMI-stratified models, DWtCP and primary cancer site remained independent predictors, whereas albumin and hs-CRP did not reach statistical individual significance, supporting the value of the composite hs-mGPS score. Conclusions: In this real-world retrospective cohort, hs-mGPS and DWtCP provided complementary prognostic information. Routine monitoring of systemic inflammation and longitudinal weight trajectories may enable pragmatic risk stratification and early identification of high-risk patients, particularly those with elevated BMI.