Chen Li, Sun Hao, Zhao Ruihu, Huang Rong, Pan Hongming, Zuo Yanjiao, Zhang Lele, Xue Yingwei, Song Hongjiang, Li Xingrui
Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China.
Front Pharmacol. 2022 Mar 4;13:836958. doi: 10.3389/fphar.2022.836958. eCollection 2022.
The controlling nutritional status (CONUT), based on total lymphocyte count (TL), total cholesterol level (T-CHOL), and serum albumin (ALB), can provide a useful immunological prognostic biomarker for cancer patients. The present study aims to investigate the correlation between CONUT and prognosis in gastric cancer patients receiving immune checkpoint inhibitor (ICI) treatment. We retrospectively enrolled 146 patients with gastric cancer treated with ICIs (PD-1/PD-L1 inhibitors) from August 2016 to December 2020. The clinicopathologic characteristics were analyzed by Chi-square test or Fisher's exact test. The Kaplan-Meier and log-rank test were used to calculate and compare progression-free survival (PFS) and overall survival (OS). The prognostic and predictive factors of PFS and OS were identified by univariate and multivariate analyses. A nomogram was developed to estimate 1-, 3-, and 5-year PFS and OS probability. Through the CONUT score, there were 75 (51.37%) patients in the low CONUT group and 71 (48.63%) patients in the high CONUT group. There was a correlation between the CONUT score and age ( = 0.005), pathology ( = 0.043), ALB ( = 0.020), PALB ( = 0.032), and Hb ( = 0.001). The CA724, TNM stage, and treatment (ICIs vs. chemotherapy) were the independent prognostic factors for PFS and OS by multivariate analyses. Patients with high CONUT score had poorer PFS and OS (χ = 3.238, = 0.072, and χ = 4.298, = 0.038). In the subgroup analysis, the patients with high CONUT score were associated with shorter PFS and OS with ICIs or chemotherapy. With the PD-1/PD-L1 positive expression, the patients with high CONUT score had shorter PFS and OS than those with low CONUT score. Furthermore, the patients with high CA724 value were associated with shorter PFS and OS. The toxicity assessment in ICIs or chemotherapy was significantly associated with anemia. The nomograms were constructed to predict the probability of 1-, 3-, and 5-year PFS, and 1-, 3-, and 5-year OS with C-indices of 0.749 and 0.769, respectively. The CONUT, as a novel immuno-nutritional biomarker, may be useful in identifying gastric cancer patients who are unlikely to benefit from ICI treatment.
基于总淋巴细胞计数（TL）、总胆固醇水平（T-CHOL）和血清白蛋白（ALB）的控制营养状况（CONUT）可为癌症患者提供有用的免疫预后生物标志物。本研究旨在探讨CONUT与接受免疫检查点抑制剂（ICI）治疗的胃癌患者预后之间的相关性。我们回顾性纳入了2016年8月至2020年12月期间接受ICI（PD-1/PD-L1抑制剂）治疗的146例胃癌患者。通过卡方检验或Fisher精确检验分析临床病理特征。采用Kaplan-Meier法和对数秩检验计算并比较无进展生存期（PFS）和总生存期（OS）。通过单因素和多因素分析确定PFS和OS的预后及预测因素。绘制列线图以估计1年、3年和5年的PFS和OS概率。根据CONUT评分，低CONUT组有75例（51.37%）患者，高CONUT组有71例（48.63%）患者。CONUT评分与年龄（P = 0.005）、病理（P = 0.043）、ALB（P = 0.020）、前白蛋白（PALB，P = 0.032）和血红蛋白（Hb，P = 0.001）之间存在相关性。多因素分析显示，CA724、TNM分期和治疗方式（ICI与化疗）是PFS和OS的独立预后因素。CONUT评分高的患者PFS和OS较差（χ² = 3.238，P = 0.072，χ² = 4.298，P = 0.038）。在亚组分析中，CONUT评分高的患者接受ICI或化疗时PFS和OS较短。在PD-1/PD-L1阳性表达的患者中，CONUT评分高的患者PFS和OS比评分低的患者短。此外，CA724值高的患者PFS和OS较短。ICI或化疗中的毒性评估与贫血显著相关。构建列线图以预测1年、3年和5年PFS以及1年、3年和5年OS的概率，C指数分别为0.749和0.769。CONUT作为一种新型免疫营养生物标志物，可能有助于识别不太可能从ICI治疗中获益的胃癌患者。
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