[Exploration of biomarkers for the efficacy of anti-PD-1 immunotherapy in patients with gastric cancer peritoneal metastasis].

Q3 Medicine
Y T Wei, Y Wang, J Yang, H B Wang, X Y Zhou, Y F Pan, S J Ren, W Q Liu, B R Liu, J Wei
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引用次数: 0

Abstract

Objective: To explore the prognosis of patients with gastric cancer peritoneal metastasis (PM) receiving programmed cell death-1 (PD-1) antibody therapy, and investigate the biomarkers that affect the prognosis of anti-PD-1 therapy. Methods: This restrospecific study collected the clinic-pathological data of 56 patients with peritoneal metastasis of gastric cancer who received first-line treatment in the Nanjing Drum Town Hospital from March 2020 to September 2023, among which 41 had received anti-PD-1 immunotherapy and 15 hadn't. The relationship between overall survival (OS) and anti-PD-1 immunotherapy was evaluated by Kaplan-Meier analysis. The relationship between baseline peripheral blood indicators and treatment response of patients with anti-PD-1 treatment was analyzed using unpaired t-test. Subsequently, the COX proportional risk regression model was used to explore the clinical prognostic factors that may affect anti-PD-1 immunotherapy by univariate and multivariate analysis. The clinical prognostic factors included baseline data and baseline peripheral blood indexes such as anti-PD-1 treatment lines, Eastern Cooperative Oncology Group performance status (ECOG PS), combined positive score (CPS), expression of human epidermal growth factor receptor 2 (Her-2), EBER status, pathological types, other metastatic lesions, ascites content before immunotherapy, with or without abdominal drainage during anti-PD-1 treatment, blood lipid indicators, inflammatory indicators, and tumor indicators. Results: Kaplan-Meier survival statistics showed similar OS (15.9 vs. 15.2 months, P=0.6002) in patients with anti-PD-1 therapy compared to those without anti-PD-1 therapy. Patients with baseline high-density lipoprotein (HDL) ≥0.97 mmol/L (n=22) demonstrated a significantly longer median OS compared to those with HDL<0.97 mmol/L (15.2 vs. 13.5 months; P=0.018). Similarly, the cohort with apolipoprotein A1 (ApoA1) levels ≥0.86 g/L (n=21) showed superior survival outcomes, with a median OS of 17.73 months versus 12.27 months in the ApoA1<0.86 g/L group (n=20; P=0.006). In contrast, elevated baseline alpha-fetoprotein (AFP) levels (n=2) were associated with markedly reduced survival (median OS: 5.7 vs. 15.2 months in normal AFP group, n=37; P=0.005). Notably, elevated pretreatment ApoA1 levels correlated with enhanced immunotherapy response (P=0.038). Multivariate Cox regression analysis revealed that ApoA1 deficiency (≥0.86 g/L) independently predicted better OS following PD-1 antibody therapy (hazard ratio [HR], 0.35 [95% CI, 0.12-0.98]; P=0.046) in gastric cancer patients with PM. Conclusions: In our study, it is first proposed that ApoA1 could be a significant predictor of the survival advantages of immunotherapy in gastric cancer patients with PM.

[胃癌腹膜转移患者抗pd -1免疫治疗疗效的生物标志物探索]。
目的:探讨胃癌腹膜转移(PM)患者接受程序性细胞死亡-1 (programmed cell death-1, PD-1)抗体治疗后的预后,并探讨影响抗PD-1治疗预后的生物标志物。方法:本回顾性研究收集2020年3月至2023年9月南京鼓镇医院一线治疗的56例胃癌腹膜转移患者的临床病理资料,其中41例接受了抗pd -1免疫治疗,15例未接受抗pd -1免疫治疗。通过Kaplan-Meier分析评估总生存期(OS)与抗pd -1免疫治疗的关系。采用非配对t检验分析基线外周血指标与抗pd -1治疗患者治疗反应的关系。随后,采用COX比例风险回归模型,通过单因素和多因素分析,探讨可能影响抗pd -1免疫治疗的临床预后因素。临床预后因素包括基线数据和基线外周血指标,如抗pd -1治疗线、东部肿瘤合作组工作状态(ECOG PS)、联合阳性评分(CPS)、人表皮生长因子受体2 (Her-2)表达、EBER状态、病理类型、其他转移性病变、免疫治疗前腹水含量、抗pd -1治疗期间是否腹腔引流、血脂指标、炎症指标、还有肿瘤指标。结果:Kaplan-Meier生存统计显示,接受抗pd -1治疗的患者与未接受抗pd -1治疗的患者相比,OS相似(15.9个月vs 15.2个月,P=0.6002)。基线高密度脂蛋白(HDL)≥0.97 mmol/L的患者(n=22)的中位生存期明显长于HDLP=0.018的患者。同样,载脂蛋白A1 (ApoA1)水平≥0.86 g/L的队列(n=21)显示出更好的生存结果,中位生存期为17.73个月,而ApoA1<0.86 g/L组(n=20)为12.27个月;P = 0.006)。相比之下,基线甲胎蛋白(AFP)水平升高(n=2)与生存期显著降低相关(正常甲胎蛋白组中位生存期:5.7 vs 15.2个月,n=37;P = 0.005)。值得注意的是,预处理ApoA1水平升高与免疫治疗反应增强相关(P=0.038)。多因素Cox回归分析显示,ApoA1缺乏(≥0.86 g/L)独立预测PD-1抗体治疗后更好的OS(风险比[HR], 0.35 [95% CI, 0.12-0.98];P=0.046)。结论:在我们的研究中,我们首次提出ApoA1可能是胃癌PM患者免疫治疗生存优势的重要预测因子。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
中华肿瘤杂志
中华肿瘤杂志 Medicine-Medicine (all)
CiteScore
1.40
自引率
0.00%
发文量
10433
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