Background: Immunoinflammatory and nutritional markers such as peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and onodera's prognostic nutritional index (OPNI) have gained considerable attention and revealed preliminaryly as prognostic markers in gastrointestinal stromal tumor (GIST).Methods: In this study, we firstly investigated the prognostic value of OPNI in GIST treated with or without TKIs based on the propensity score matching (PSM) method. All

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... f the patients had received surgical resection for primary GIST, the data from 2010 to 2018 were initially and retrospectively identified from our gastrointestinal center. Recurrence-free survival (RFS) was calculated by the Kaplan-Meier method and compared by the log-rank test.Results: These patients who were treated with TKIs and those who did not were divided into two groups, and we used propensity score matching method to make them have more unified baseline data. Multivariate Cox proportional hazard regression models were applied to identify associations with outcome variables. A total of 563 GISTs were initially chosen and 280 of them were included for analysis under an inclusion criteria. After PSM, there were 200 patients included. Multivariate analyses identified OPNI was an independent prognostic marker, and was associated with primary site, tumor size, mitotic index, tumor rupture, necrosis, and modified NIH risk classification. Low OPNI (<42.6; HR 0.409; P<0.001) were associated with worse RFS.Conclusions: Preoperative OPNI is a novel and useful prognostic marker for GISTs both treated with or without TKIs. Higher NLR and PLR have negative effects for RFS.