The predictive value of preoperative clinical laboratory indicators combined with sarcopenia for postoperative complications of gastric cancer

Background Postoperative complications (POCs) significantly affect recovery and prognosis in patients with gastric cancer. This retrospective cohort study aimed to develop and validate a nomogram integrating preoperative clinical laboratory indicators and sarcopenia to predict POCs in patients undergoing radical gastrectomy. Method A retrospective analysis was conducted on 181 patients who underwent radical gastrectomy for gastric cancer between October 2019 and June 2022. Patients were randomly assigned to a training set ( n = 126) and a validation set ( n = 55). Sarcopenia was defined using the skeletal muscle index (SMI) measured at the third lumbar vertebra on preoperative computed tomography (CT) images. Univariate and multivariate logistic regression analyses were performed to identify risk factors for POCs (Clavien–Dindo grade ≥ II). A predictive nomogram was constructed based on independent risk factors, and model performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Results Inter-observer consistency for SMI measurement was excellent (intraclass correlation coefficient [ICC] = 0.86). Univariate analysis revealed that clinical N stage, carcinoembryonic antigen (CEA) level, sarcopenia, and CT-assessed serosal invasion were significantly associated with POCs (all p < 0.05). The nomogram incorporating these four factors showed good predictive performance, with AUCs of 0.865 (95% confidence interval [CI]: 0.794–0.936) in the training set and 0.826 (95% CI: 0.704–0.948) in the validation set. Calibration curves demonstrated good agreement between predicted and observed probabilities, and DCA confirmed the model’s clinical utility. Conclusion The nomogram integrating preoperative CEA, sarcopenia, CT-assessed serosal invasion, and clinical N stage effectively predicts the risk of postoperative complications in gastric cancer patients, facilitating preoperative risk stratification and personalized perioperative management.