Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Division of Hematology/Oncology, Department of Internal Medicine, Konyang University Hospital, Daejeon, South Korea.
Gastric Cancer. 2024 Jul;27(4):840-849. doi: 10.1007/s10120-024-01509-2. Epub 2024 May 23.
We aimed to investigate clinicopathologic factors leading to different clinical outcomes in patients with deficient mismatch repair protein (d-MMR) gastric cancer (GC) treated with nivolumab plus chemotherapy (nivolumab chemotherapy).
This retrospective study included 28 patients with d-MMR advanced GC treated with first-line nivolumab chemotherapy. As a control group, 68 treated with first-line chemotherapy alone were included. Clinicopathological factors, including the neutrophil-to-lymphocyte ratio (NLR) and PD-L1 combined positive score (CPS), were analyzed with regards to the efficacy outcomes.
Progression-free survival (PFS) was longer (median PFS; not reached [NR] vs. 5.2 months, hazard ratio [HR] 0.28, P < 0.001), and overall survival (OS) tended to be longer (median OS; NR vs. 17.9 months, HR 0.43, P = 0.057) in patients treated with nivolumab chemotherapy than those treated with chemotherapy. The PFS benefit of nivolumab chemotherapy over chemotherapy was pronounced in the subgroup with a lower NLR (< 3.80 [median NLR]) (HR 0.10), whereas it was less prominent in patients with a high NLR (≥ 3.80) (HR 0.58). Among patients treated with nivolumab chemotherapy, PFS was worse in patients with a higher NLR (≥ 3.80) than in those with a lower NLR (< 3.80), and survival outcomes were similar between those with PD-L1 CPS ≥ 5 and < 5.
Nivolumab chemotherapy was associated with better efficacy outcomes than chemotherapy alone among patients with d-MMR GC, but survival outcomes were poor even with nivolumab chemotherapy for those with a high NLR. Survival outcomes were not different according to PD-L1 CPS among d-MMR patients treated with nivolumab chemotherapy.
我们旨在研究错配修复蛋白缺陷（d-MMR）胃癌（GC）患者接受纳武利尤单抗联合化疗（纳武利尤单抗化疗）治疗时导致不同临床结局的临床病理因素。
本回顾性研究纳入了 28 例接受一线纳武利尤单抗化疗的 d-MMR 晚期 GC 患者。作为对照组，纳入了 68 例接受一线单纯化疗的患者。分析了中性粒细胞与淋巴细胞比值（NLR）和 PD-L1 联合阳性评分（CPS）等临床病理因素与疗效结局的关系。
纳武利尤单抗化疗组无进展生存期（PFS）较长（中位 PFS；未达到[NR] vs. 5.2 个月，风险比[HR] 0.28，P<0.001），总生存期（OS）也有延长趋势（中位 OS；NR vs. 17.9 个月，HR 0.43，P=0.057）。与化疗组相比，纳武利尤单抗化疗组在 NLR 较低（<3.80[中位 NLR]）的亚组中，PFS 获益更为显著（HR 0.10），而在 NLR 较高（≥3.80）的患者中，PFS 获益则不显著（HR 0.58）。在接受纳武利尤单抗化疗的患者中，NLR 较高（≥3.80）的患者 PFS 较 NLR 较低（<3.80）的患者差，而 PD-L1 CPS≥5 和<5 的患者生存结局相似。
与单纯化疗相比，纳武利尤单抗化疗在 d-MMR GC 患者中疗效更好，但对于 NLR 较高的患者，即使使用纳武利尤单抗化疗，生存结局也较差。在接受纳武利尤单抗化疗的 d-MMR 患者中，PD-L1 CPS 对生存结局无影响。
