Zhong Chenming, Yuan Ying, Jiang Yue, Qiao Guanglei, Deng Zhoufeng, Liu Zimei, Yu Liping, Lin Hongjian, Mao Jiuang, Ma Lijun, Zhang Jianjun
Department of Oncology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Discov Oncol. 2025 Apr 26;16(1):618. doi: 10.1007/s12672-025-01857-0.
Immune checkpoint inhibitors (ICIs) plus chemotherapy have become a new first-line treatment option for patients with locally advanced or metastatic gastric cancer. However, it is still controversial whether to choose chemotherapy alone or ICIs plus chemotherapy as the first-line treatment option due to a lack of ideal predictive biomarkers for the efficacy. This study intended to explore the predictive value of inflammatory markers for the efficacy of first-line ICIs plus chemotherapy in this disease.
This retrospective study included 131 patients with locally advanced or metastatic gastric cancer who received first-line treatment between July, 2020 and June, 2023. Among them, 76 received first-line ICIs plus chemotherapy and 55 received chemotherapy alone. Firstly, Kaplan-Meier and Cox regression analyses were used to explore the correlation between inflammatory markers and efficacy of first-line ICIs plus chemotherapy. Subsequently, the predictive value of combined baseline and dynamic changes in inflammatory markers was explored. Moreover, the predictive value of baseline inflammatory markers was further verified by comparing efficacy of ICIs plus chemotherapy with that of chemotherapy alone.
In patients receiving first-line ICIs plus chemotherapy, low baseline monocyte-to-lymphocyte ratio (MLR) in peripheral blood was significantly associated with better progression-free survival (PFS) and overall survival (OS), and was an independent prognostic factor for OS. In addition, dynamic early changes of MLR also played predictive role. Patients whose MLR was lower at baseline and after two cycles of treatment had better OS (P = 0.009). Furthermore, compared to chemotherapy alone, patients with a lower baseline MLR were more likely to benefit from first-line ICIs plus chemotherapy.
MLR could serve as a new biomarker to predict the efficacy of first-line ICIs plus chemotherapy in patients with locally advanced or metastatic gastric cancer. And it is helpful to select the candidates for first-line ICIs plus chemotherapy, which is worthy of further study.
免疫检查点抑制剂（ICI）联合化疗已成为局部晚期或转移性胃癌患者新的一线治疗选择。然而，由于缺乏理想的疗效预测生物标志物，对于一线治疗选择单独化疗还是ICI联合化疗仍存在争议。本研究旨在探讨炎症标志物对该疾病一线ICI联合化疗疗效的预测价值。
本回顾性研究纳入了2020年7月至2023年6月期间接受一线治疗的131例局部晚期或转移性胃癌患者。其中，76例接受一线ICI联合化疗，55例仅接受化疗。首先，采用Kaplan-Meier法和Cox回归分析探讨炎症标志物与一线ICI联合化疗疗效之间的相关性。随后，探讨炎症标志物基线和动态变化的联合预测价值。此外，通过比较ICI联合化疗与单纯化疗的疗效，进一步验证基线炎症标志物的预测价值。
在接受一线ICI联合化疗的患者中，外周血基线单核细胞与淋巴细胞比值（MLR）较低与更好的无进展生存期（PFS）和总生存期（OS）显著相关，并且是OS的独立预后因素。此外，MLR的动态早期变化也发挥了预测作用。基线和两个周期治疗后MLR较低的患者OS较好（P = 0.009）。此外，与单纯化疗相比，基线MLR较低的患者更有可能从一线ICI联合化疗中获益。
MLR可作为预测局部晚期或转移性胃癌患者一线ICI联合化疗疗效的新生物标志物。并且有助于选择一线ICI联合化疗的候选患者，值得进一步研究。
