The Effect of Inflammatory Markers on the Survival of Advanced Gastric Cancer Patients Who Underwent Anti-Programmed Death 1 Therapy

Abstract

PurposeThis clinical study sought to determine whether the levels of inflammatory markers predicted the survival of advanced gastric cancer (AGC) patients who underwent anti-programmed death 1 (PD-1) therapy.MethodsUsing AGC patient plasma samples and baseline characteristics, we investigated the specific value of inflammatory markers in AGC from a clinical perspective in immunotherapy.ResultsOne hundred and six patients with AGC who underwent anti-PD-1 therapy were enrolled in this study between 20 July 2019 and 16 March 2021. A significant decrease in NLR, dNLR, and SII was noticed among the PR (P=0.023; P=0.036; P=0.001), SD (P=0.048; P=0.022; P=0.023), ORR (P=0.021; P=0.032; P=0.001), and DCR (P=0.003; P=0.001; P<0.001) groups after anti-PD-1 therapy. Additionally, a significant decline of PLR was also observed in PR (P=0.010), ORR (P=0.007), and DCR (P=0.005) after anti-PD-1 therapy. Only MLR levels increased significantly at the time of anti-PD-1 immunotherapy the failure compared to baseline (P=0.039). And statistically significant elevations in NLR (P=0.001), MLR (P=0.020), dNLR (P=0.002), and SII (P=0.019) were found in failure of anti-PD-1 treatment compared to optimal efficacy in AGC patients. In first-line treatment, the number of metastatic sites (P=0.001) was an independent prognostic factor for PFS, and peritoneal metastases (P=0.004) and platelet-to-lymphocyte ratio (PLR) level (P=0.014) were independent prognostic predictors of OS according to Cox regression analysis. In second-line or posterior treatment, the number of metastatic sites (P=0.007), ECOG (P=0.011), and PLR level (P=0.033) were independent prognostic factors for PFS in AGC patients, and the number of metastatic sites (P=0.003), differentiation (P=0.030), and NLR level (P<0.001) were independent prognostic factors for OS according to Cox regression analysis.ConclusionsNLR, PLR, MLR, dNLR, and SII can reflect the short-term efficacy of immunotherapy in patients who underwent anti-PD-1 therapy with AGC. PLR is an independent prognostic factor for OS in AGC patients receiving first-line immunotherapy and PFS in those receiving second-line or posterior immunotherapy. And NLR was an independent prognostic factor for OS in AGC patients receiving second-line or posterior immunotherapy. The number of metastatic sites was significantly associated with the prognosis of AGC patients who received immunotherapy.

Prognostic value of inflammatory markers and clinical features for survival in advanced or metastatic esophageal squamous cell carcinoma patients receiving anti-programmed death 1 treatment

“…Serum inflammatory markers have the advantages of being convenient, repeatable and inexpensive in comparison to current biomarkers like PD-L1 and MSI. Thus, their predictive or prognostic value has been systematically analyzed in a variety of cancers such as NSCLC ( 26 ), renal cancer ( 27 ), as well as gastric cancer ( 28 ). Similar studies were also performed in EC patients treated with immunotherapy.…”

Association of inflammatory markers with survival in patients with advanced gastric cancer treated with immune checkpoint inhibitors combined with chemotherapy as first line treatment

“…More recent evidence has shown that inflammatory markers can predict short-term efficacy of immunotherapy in advanced gastric cancer patients. A study comprising 37 patients with advanced gastric cancer treated with first-line immunotherapy showed that PLR was an independent predictor of the OS but not the PFS ( 22 ). The baseline and early changes of MLR have been shown to influence survival outcomes in advanced gastric cancer on different lines ( 23 ).…”

“…At present, most studies on inflammatory factors in gastric cancer treated with immunotherapy are based on single cohorts. Little focus has been paid to the identification of the function of MLR in patients using real-world cohorts ( 22 ). Based on results obtained from the clinical trial cohort, we concluded that NLR was an independent prognostic factor, a finding that was validated in the real-world cohort.…”

Platelet‑to‑lymphocyte and neutrophil‑to‑lymphocyte ratios are associated with the efficacy of immunotherapy in stage III/IV non‑small cell lung cancer

“…Asher et al (30) reported that PLR was an independent prognostic marker in patients with ovarian cancer and revealed that higher PLR values were associated with poorer prognosis. Qu et al (31) demonstrated that NLR and PLR could be used as predictors of near-term outcome in patients with advanced gastric cancer receiving immunotherapy. In addition, Song et al (32) evaluated 389 patients receiving concurrent radiotherapy, and revealed that higher NLR and PLR values were associated associations were not observed in multivariate analysis; this finding is consistent with those of previous studies (30,32).…”