The Prognostic Value of Gastric Immune Prognostic Index in Gastric Cancer Patients Treated With PD-1/PD-L1 Inhibitors

Abstract

Objective: This study aimed to investigate the prognostic value of the gastric immune prognostic index (GIPI) in gastric cancer patients treated with programmed death 1/programmed death-ligand 1 (PD-1/PD-L1) inhibitors.Methods: This study was conducted to elucidate the role of GIPI using the data from 146 gastric cancer patients treated with PD-1/PD-L1 inhibitors between August 2016 and December 2020 in Harbin Medical University Cancer Hospital. The GIPI calculation was based on dNLR and LDH. Patients were categorized into three groups: 1) GIPI good (LDH ≤250 U/L and dNLR ≤3); 2) GIPI intermediate (LDH >250 U/L and NLR >3); 3) GIPI poor (LDH >250 U/L and dNLR >3). The correlations between GIPI and clinicopathologic characteristics were determined by the Chi-square test or the Fisher’s exact test. The Kaplan–Meier analysis and log-rank test were used to calculate and compare progression-free survival (PFS) and overall survival (OS). The univariate and multivariate Cox proportional hazards regression model was used to detect prognostic and predictive factors of PFS and OS.Results: 146 patients treated with PD-1/PD-L1 inhibitors were included in this study, of which, 72.6% were GIPI good, 23.3% were GIPI intermediate, and 4.1% were GIPI poor. The GIPI was associated with the common blood parameters, including neutrophils and lymphocytes. The multivariate analysis showed that platelet, TNM stage, and treatment were the independent prognostic factors for PFS and OS. Patients with GIPI intermediate/poor were associated with shorter PFS (median: 24.63 vs. 32.50 months; p = 0.078) and OS (median: 28.37 months vs. not reached; p = 0.033) than those with GIPI good. GIPI intermediate/poor was correlated with shorter PFS and OS than GIPI good, especially in subgroups of patients with ICI treatment and patients with PD-1/PD-L1 positive status.Conclusions: The GIPI correlated with poor outcomes for PD-1/PD-L1 expression status and may be useful for identifying gastric cancer patients who are unlikely to benefit from treatment.

Preoperative lung immune prognostic index predicts survival in patients with pancreatic cancer undergoing radical resection

“…The combination of dNLR and LDH, also known as LIPI, was first revealed as a prognostic factor for advanced NSCLC patients treated with immune checkpoint inhibitors (20). More and more studies indicated that LIPI was associated with therapeutic outcomes in many malignancies (14,(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). However, there is a lack of researches exploring the value of preoperative LIPI in the outcomes of resectable PDAC patients treated with radical surgery.…”

“…More recently, there has been growing interest in extra-pulmonary cancer. LIPI has been reported to be predictive of the benefit of immunotherapy in other solid tumors (26,27). It was also related to the prognosis of patients with osteosarcoma receiving standard treatment (28), esophageal squamous cell carcinoma undergoing curative surgery (29) or chemoradiotherapy (30), urothelial bladder cancer receiving radical cystectomy (31), and advanced breast cancer patients treated with trastuzumab emtansine (14).…”

Association of the CD4+ /CD8+ ratio with response to PD-1 inhibitor-based combination therapy and dermatologic toxicities in patients with advanced gastric and esophageal cancer

“…For example, the KEYNOTE-059 trial showed that, in metastatic GC or gastroesophageal junction cancer, the e cacy (ORR: 15.5% vs.6.4%) and the median duration of response (16.3 vs. 8.4 months) of patients with positive PD-L1 expression was far better than that of patients with negative PD-L1 expression [41]. Likewise, several studies have demonstrated that PD-L1 expression alone, or with other factors, is positively associated with the clinical bene ts of PD-1/PD-L1 inhibitors [42][43][44].…”

Potential diagnostic, prognostic, and predictive biomarkers of gastric cancer

“… 86 , 87 A cutting‐edge treatment for GC involves inhibiting immunological checkpoints and targeting the PD‐1 pathway. 88 When the combined positive score (the number of PD‐L1‐positive cells, including tumor cells, macrophages, and lymphocytes, divided by the total number of viable tumor cells, multiplied by 100) is one or higher, tumors are deemed to be PD‐L1‐positive. 89 …”