Hu Jianli, Yang Shengli, Wang Jing, Zhang Qiuyue, Zhao Lei, Zhang Dejun, Yu Dandan, Jin Min, Ma Hong, Liu Hongli, Xue Jun, Zhang Tao
Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Ann Transl Med. 2021 Aug;9(16):1316. doi: 10.21037/atm-21-3376.
Immune checkpoint blockade is effective against many cancer types, but few patients achieve a complete response (OR). Therefore, effective prognostic biomarkers are needed for metastatic gastric cancer (GC) patients after immune treatment. The present study assessed the value of hematological parameters as markers of the effectiveness of immune checkpoint blockade among metastatic GC patients.
This retrospective study included patients with metastatic GC who underwent multiline chemotherapy including at least two courses of immunotherapy between September 2018 and December 2020. Patient and tumor characteristics were tested for prognostic significance by analysis of variance or chi-square test. Kaplan-Meier and Cox analyses were performed to identify factors associated with progression-free survival (PFS).
Sixty-one GC patients (mean age 55.61±11.97 years, range 23-80 years, 24 females, and 37 males) were included, and 27, 9 and 25 cases had organ only, peritoneum only, and simultaneous organ and peritoneum metastasis, respectively. Gastrectomy was performed in 24 cases, and there was no operative treatment in the other 37 cases, while all patients received two or more lines of chemotherapy. After immune treatment, 13 patients achieved a partial response (PR), 16 stable disease (SD), and 32 progressive disease (PD). The median PFS was 4.93±3.47 months. An alkaline phosphatase (ALP) level >225 U/L, a lactate dehydrogenase level (LDH) >299 U/L, and a body mass index (BMI) >24 kg/m were associated with a short PFS (P=0.01, P=0.008, and P=0.039, respectively). A Cox multivariate proportional hazard model indicated that higher ALP level was a significant prognostic indicator for adverse PFS.
Our data show an ALP cutoff of 225 U/L offered good prognostic sensitivity for HER2-negative metastatic GC. ALP measurement represents a convenient, cost-effective, and relatively sensitive screening tool, and prospective studies involving its evaluation in addition to other biomarkers in metastatic GC patients are indicated.
免疫检查点阻断对多种癌症类型有效，但很少有患者能达到完全缓解（OR）。因此，需要有效的预后生物标志物来评估转移性胃癌（GC）患者免疫治疗后的情况。本研究评估了血液学参数作为转移性GC患者免疫检查点阻断疗效标志物的价值。
这项回顾性研究纳入了2018年9月至2020年12月期间接受多线化疗（包括至少两个疗程免疫治疗）的转移性GC患者。通过方差分析或卡方检验对患者和肿瘤特征进行预后意义检验。采用Kaplan-Meier法和Cox分析法确定无进展生存期（PFS）的相关因素。
纳入61例GC患者（平均年龄55.61±11.97岁，范围23 - 80岁，女性24例，男性37例），其中27例、9例和25例分别仅有器官转移、仅有腹膜转移以及同时有器官和腹膜转移。24例患者接受了胃切除术，其余37例未接受手术治疗，所有患者均接受了两线或更多线化疗。免疫治疗后，13例患者达到部分缓解（PR），16例病情稳定（SD），32例病情进展（PD）。中位PFS为4.93±3.47个月。碱性磷酸酶（ALP）水平>225 U/L、乳酸脱氢酶水平（LDH）>299 U/L以及体重指数（BMI）>24 kg/m²与较短的PFS相关（分别为P = 0.01、P = 0.008和P = 0.039）。Cox多变量比例风险模型表明，较高的ALP水平是不良PFS的显著预后指标。
我们的数据表明，ALP临界值为225 U/L对HER2阴性转移性GC具有良好的预后敏感性。ALP检测是一种方便、经济有效且相对敏感的筛查工具，有必要开展前瞻性研究，在转移性GC患者中除评估其他生物标志物外，还对其进行评估。
