{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:21:05Z","timestamp":1788153665294,"version":"build-2803163510"},"reference-count":26,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T00:00:00Z","timestamp":1788048000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007452","name":"Wu Jieping Medical Foundation","doi-asserted-by":"publisher","award":["320.6750.2022-07-13"],"award-info":[{"award-number":["320.6750.2022-07-13"]}],"id":[{"id":"10.13039\/100007452","id-type":"DOI","asserted-by":"publisher"}]},{"award":["320.6750.2022-07-13"],"award-info":[{"award-number":["320.6750.2022-07-13"]}],"id":[{"id":"https:\/\/ror.org\/05dgwj702","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Peritoneal metastasis (PM) is a lethal and often occult event in advanced gastric cancer (GC), and its preoperative detection remains difficult. The role of peripheral NK and NKT\u2212like cells in predicting PM has not been well defined. Methods: We retrospectively analyzed 433 patients who underwent surgery for GC from 2016 to 2020. Patients were stratified by PM status and randomly assigned to training and held\u2212out internal validation cohorts. Flow cytometry\u2212derived lymphocyte subset percentages were treated as compositional data, and NK and NKT\u2212like cell variables were entered into the model after log\u2212ratio transformation. Candidate variables were selected using LASSO logistic regression in the training cohort and further assessed by multivariable logistic regression. Model performance was evaluated using AUROC, AUPRC, and confusion matrices in the validation cohort. Nomogram and SHAP analyses were used for model interpretation. Results: Seven predictors were retained in the final model: log\u2212ratio\u2212transformed NKT\u2212like cells, direct bilirubin, prealbumin, lymphocyte count, lactate dehydrogenase, CA125, and log\u2212ratio\u2212transformed NK cells. The model achieved an AUROC of 0.879 (95% CI: 0.805\u20130.936) and an AUPRC of 0.698 (95% CI: 0.524\u20130.848) in the validation cohort. At the conventional threshold of 0.50, the model achieved an accuracy of 0.915, sensitivity of 0.821, specificity of 0.941, PPV of 0.793, and NPV of 0.950. At the Youden\u2212optimal threshold of 0.101, sensitivity, specificity, accuracy, PPV, and NPV were 1.000, 0.892, 0.915, 0.718, and 1.000, respectively. Conclusions: A preoperative model integrating log\u2212ratio\u2212transformed NK\/NKT\u2212like cell variables and routine hematological parameters showed good ability to identify PM in GC and may help select patients for diagnostic laparoscopy or closer preoperative evaluation.<\/jats:p>","DOI":"10.3390\/cancers18172813","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T04:24:03Z","timestamp":1788150243000},"page":"2813","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Logistic Regression Model Integrating Flow Cytometry\u2212Derived Immune Cell Profiles and Hematological Parameters for Preoperative Prediction of Peritoneal Metastasis in Gastric Cancer"],"prefix":"10.3390","volume":"18","author":[{"given":"Ruihu","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Yuming","family":"Ju","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"software","vocabulary":"credit"}]},{"given":"Zhichao","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"}]},{"given":"Yingwei","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Hongjiang","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,30]]},"reference":[{"key":"ref_1","first-page":"e70043","article-title":"Cancer statistics, 2026","volume":"76","author":"Siegel","year":"2026","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1001\/jama.2025.20034","article-title":"Gastric Cancer: A Review","volume":"335","author":"Patel","year":"2026","journal-title":"JAMA"},{"key":"ref_4","first-page":"49","article-title":"The contemporary management of peritoneal metastasis: A journey from the cold past of treatment futility to a warm present and a bright future","volume":"73","author":"Foster","year":"2023","journal-title":"CA Cancer J. Clin."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1002\/ijc.28373","article-title":"Peritoneal carcinomatosis of gastric origin: A population\u2212based study on incidence, survival and risk factors","volume":"134","author":"Thomassen","year":"2014","journal-title":"Int. J. Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1200\/jco.2016.34.4_suppl.14","article-title":"Preoperative prediction of peritoneal metastasis in gastric cancer as an indicator for neoadjuvant treatment","volume":"34","author":"Mori","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e16022","DOI":"10.1200\/JCO.2022.40.16_suppl.e16022","article-title":"Prediction of peritoneal cancer index and prognosis in peritoneal metastasis of gastric cancer using NLR\u2212PLR\u2212DDI score","volume":"40","author":"Jiang","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s13046-023-02629-w","article-title":"L\u2212kynurenine induces NK cell loss in gastric cancer microenvironment via promoting ferroptosis","volume":"42","author":"Cui","year":"2023","journal-title":"J. Exp. Clin. Cancer Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.it.2013.07.005","article-title":"Location and cellular stages of natural killer cell development","volume":"34","author":"Yu","year":"2013","journal-title":"Trends Immunol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1038\/s41586-021-03752-4","article-title":"Transcriptional programs of neoantigen\u2212specific TIL in anti\u2212PD\u22121\u2212treated lung cancers","volume":"596","author":"Caushi","year":"2021","journal-title":"Nature"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1038\/s41590-023-01620-z","article-title":"Control of nutrient uptake by IRF4 orchestrates innate immune memory","volume":"24","author":"Santosa","year":"2023","journal-title":"Nat. Immunol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1038\/s42255-024-01188-4","article-title":"Pivotal role of exogenous pyruvate in human natural killer cell metabolism","volume":"7","author":"Picq","year":"2025","journal-title":"Nat. Metab."},{"key":"ref_13","first-page":"768","article-title":"A Unified Approach to Interpreting Model Predictions","volume":"30","author":"Lundberg","year":"2017","journal-title":"Adv. Neural Inf. Process. Syst."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"41305","DOI":"10.18632\/oncotarget.17181","article-title":"A nomogram based on serum bilirubin and albumin levels predicts survival in gastric cancer patients","volume":"8","author":"Sun","year":"2017","journal-title":"Oncotarget"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Yi, F., Tao, S., and Wu, H. (2025). Bilirubin metabolism in relation to cancer. Front. Oncol., 15.","DOI":"10.3389\/fonc.2025.1570288"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"De Simone, G., di Masi, A., and Ascenzi, P. (2021). Serum Albumin: A Multifaced Enzyme. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms221810086"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e16528","DOI":"10.1200\/JCO.2020.38.15_suppl.e16528","article-title":"Prognostic value of baseline complete blood count components in advanced gastric cancer patients: A multicenter retrospective study","volume":"38","author":"Elsamany","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Gao, C., Dan Zeng, C.D., Tong, Y.X., Zhu, L., and Zhang, S. (2022). Preoperative Low Prealbumin Is Associated With Recurrence in Patients With Stage II\/III Gastric Cancer After Laparoscopic D2 Gastrectomy. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.819514"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00268-021-06384-x","article-title":"Increased Rate of Serum Prealbumin Level after Preoperative Enteral Nutrition as an Indicator of Morbidity in Gastrectomy for Gastric Cancer with Outlet Obstruction","volume":"46","author":"Izumi","year":"2022","journal-title":"World J. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s12014-020-09297-4","article-title":"A nomogram based on glycomic biomarkers in serum and clinicopathological characteristics for evaluating the risk of peritoneal metastasis in gastric cancer","volume":"17","author":"Zhao","year":"2020","journal-title":"Clin. Proteom."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2635","DOI":"10.1038\/s41388-024-03114-0","article-title":"Single\u2212cell profiling reveals altered immune landscape and impaired NK cell function in gastric cancer liver metastasis","volume":"43","author":"Tang","year":"2024","journal-title":"Oncogene"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Zhao, Y., Bai, Y., Shen, M., and Li, Y. (2022). Therapeutic strategies for gastric cancer targeting immune cells: Future directions. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.992762"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"55222","DOI":"10.18632\/oncotarget.10484","article-title":"Altered phenotypic and functional characteristics of CD3+CD56+ NKT\u2212like cells in human gastric cancer","volume":"7","author":"Peng","year":"2016","journal-title":"Oncotarget"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2009666","DOI":"10.1080\/2162402X.2021.2009666","article-title":"The role of NKT cells in gastrointestinal cancers","volume":"11","author":"Burks","year":"2022","journal-title":"Oncoimmunology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e70056","DOI":"10.1111\/cts.70056","article-title":"Practical guide to SHAP analysis: Explaining supervised machine learning model predictions in drug development","volume":"17","author":"Schmitt","year":"2024","journal-title":"Clin. Transl. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1038\/s41598-025-31079-x","article-title":"Interpretable ensemble learning for tumor\u2212type prediction with a SHAP\u2212based evaluation of CatBoost and voting classifiers","volume":"16","author":"Wolak","year":"2025","journal-title":"Sci. Rep."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/17\/2813\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T04:52:12Z","timestamp":1788151932000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/17\/2813"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,30]]},"references-count":26,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["cancers18172813"],"URL":"https:\/\/doi.org\/10.3390\/cancers18172813","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,30]]}}}