目的：探讨第三腰椎骨骼肌指数(L₃ SMI)在晚期胃癌患者营养风险评估及预后中的应用价值。方法：回顾性分析2016年1月至2019年12月在海军军医大学附属长海医院肿瘤科收治的71例晚期胃癌患者的临床资料，根据L₃ SMI值将患者分为高SMI组和低SMI组。比较两组间的临床基线资料和营养指标结果差异。根据单因素分析结果筛选有意义的变量作多因素COX比例风险回归分析，并构建列线图。结果：与低SMI组比较，高SMI组年龄更小、OPNI指数更高、原发部位在胃体的比例更高，差异均有统计学意义(均P＜0.05)。COX比例风险回归分析及列线图显示，L₃ SMI是影响患者总生存期(OS)的最大预测因子，其次是OPNI和肿瘤原发部位，年龄因素对晚期胃癌患者OS的预测价值最小。L₃ SMI预测晚期胃癌患者6个月内生存期效果最佳。结论：L₃ SMI可作为晚期胃癌患者生存的预测指标。

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