Wang Yuyang, Li Yi, Guo Yusheng, Jiang Shanshan, Lou Jie, Gong Bingxin, Li Zhiying, Yang Lian, Zhou Guofeng
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1277, Wuhan, 430022, China.
Hubei Provincial Clinical Research Center for Precision Radiology & Interventional Medicine, Wuhan, 430022, China.
BMC Cancer. 2025 Jun 5;25(1):1009. doi: 10.1186/s12885-025-14411-6.
Gastric cancer remains a leading cause of cancer-related mortality. While immune checkpoint inhibitors (ICIs) have emerged as promising therapies, their efficacy is hindered by the lack of robust patient-centric biomarkers. Obesity, traditionally linked to cancer risk, paradoxically correlates with improved immunotherapy responses in some cancers, termed the "obesity paradox". However, traditional measurements like body mass index (BMI) may not fully capture metabolic-immune interactions. This study evaluates the predictive significance of lipid accumulation product (LAP) and visceral adiposity index (VAI), two metabolic indices, in gastric cancer patients receiving programmed death receptor-1 (PD-1) inhibitors.
A retrospective study was conducted on 146 gastric adenocarcinoma patients (stage III: n = 61; stage IV: n = 85) treated with PD-1 inhibitors at Wuhan Union Hospital from September 5, 2020, to October 15, 2023. We evaluated two metabolic obesity indices: LAP and VAI. LAP was calculated using waist circumference (WC) and triglyceride (TG) levels, while VAI incorporated WC, BMI, TG, and high-density lipoprotein cholesterol (HDL-C), with gender-specific formulas. Measurements followed standardized protocols with biochemical assays. Patients were stratified into high/low LAP and VAI groups using X-tile-derived optimal cut-offs. Survival outcomes were analyzed through Kaplan-Meier curves with log-rank testing. Prognostic factors were identified via univariate and multivariate Cox regression analyses. Subgroup analyses further validated the model's robustness across clinical strata. Predictive accuracy was quantified using time-dependent receiver operating characteristic (ROC) curves, while clinical utility was assessed through decision curve analysis (DCA).
Patients with high LAP and high VAI had significantly better PFS and OS than those with lower indices (log-rank test, P < 0.001). Multivariate Cox regression analysis confirmed that high LAP (PFS: HR: 0.403, 95% CI: 0.233- 0.698, P = 0.001; OS: HR: 0.287, 95% CI: 0.153-0.541, P < 0.001) and high VAI (PFS: HR: 0.370, 95% CI: 0.214-0.642, P < 0.001; OS: HR: 0.300, 95% CI: 0.164-0.548, P < 0.001) were independent protective factors for both PFS and OS.
LAP and VAI may serve as independent predictors of long-term survival in gastric cancer patients undergoing immunotherapy.
胃癌仍然是癌症相关死亡的主要原因。虽然免疫检查点抑制剂（ICIs）已成为有前景的治疗方法，但其疗效因缺乏强大的以患者为中心的生物标志物而受到阻碍。肥胖传统上与癌症风险相关，但矛盾的是，在某些癌症中，肥胖与免疫治疗反应的改善相关，这被称为“肥胖悖论”。然而，像体重指数（BMI）这样的传统测量方法可能无法完全捕捉代谢与免疫的相互作用。本研究评估了脂质蓄积产物（LAP）和内脏脂肪指数（VAI）这两个代谢指标在接受程序性死亡受体1（PD - 1）抑制剂治疗的胃癌患者中的预测意义。
对2020年9月5日至2023年10月15日在武汉协和医院接受PD - 1抑制剂治疗的146例胃腺癌患者（III期：n = 61；IV期：n = 85）进行了一项回顾性研究。我们评估了两个代谢性肥胖指标：LAP和VAI。LAP使用腰围（WC）和甘油三酯（TG）水平计算，而VAI纳入了WC、BMI、TG和高密度脂蛋白胆固醇（HDL - C），并采用了特定性别的公式。测量遵循标准化方案并进行生化检测。使用X - tile推导的最佳截断值将患者分为高/低LAP和VAI组。通过Kaplan - Meier曲线和对数秩检验分析生存结果。通过单因素和多因素Cox回归分析确定预后因素。亚组分析进一步验证了模型在不同临床分层中的稳健性。使用时间依赖性受试者工作特征（ROC）曲线量化预测准确性，同时通过决策曲线分析（DCA）评估临床实用性。
高LAP和高VAI的患者的无进展生存期（PFS）和总生存期（OS）显著优于指标较低的患者（对数秩检验，P < 0.001）。多因素Cox回归分析证实，高LAP（PFS：风险比[HR]：0.403，95%置信区间[CI]：0.233 - 0.698，P = 0.001；OS：HR：0.287，95% CI：0.153 - 0.541，P < 0.001）和高VAI（PFS：HR：0.370，95% CI：0.214 - 0.642，P < 0.001；OS：HR：0.300，95% CI：0.164 - 0.548，P < 0.001）是PFS和OS的独立保护因素。
LAP和VAI可能作为接受免疫治疗的胃癌患者长期生存的独立预测指标。
