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. 2023 Nov 10;23(1):1095.
doi: 10.1186/s12885-023-11620-9.

Impact of low serum iron on treatment outcome of PD-1 inhibitors in advanced gastric cancer

Yu Yang  1   2 , Ya Li  3 , Zhendong Chen  4   3
Affiliations

Impact of low serum iron on treatment outcome of PD-1 inhibitors in advanced gastric cancer

Yu Yang et al. BMC Cancer. .

Abstract

Background: The aim of this study was to investigate the influence of serum iron levels in advanced gastric cancer (GC) patients treated with programmed cell death protein-1 (PD-1) inhibitors.

Methods: We retrospectively reviewed 149 GC patients who were treated with PD-1 inhibitors at our center. Clinicopathological characteristics, laboratory data, and clinical outcomes were analyzed.

Results: Multivariate analysis showed that Eastern Cooperative Oncology Group performance status (ECOG PS), histological subtype, and baseline serum iron levels were independent prognostic factors for overall survival (OS), while ECOG PS, multiple metastatic sites, and baseline serum iron levels were independent prognostic factors for progression-free survival (PFS). Patients with baseline low serum iron levels (LSI) had a significantly shorter median OS and PFS compared to patients with normal serum iron levels (NSI) (Median OS: 7 vs. 14 months, p = 0.001; median PFS: 3 vs. 5 months, p = 0.005). Patients with baseline LSI had a disease control rate (DCR) of 58.3% at 2 months after PD-1 inhibitor initiation (M2), compared to 81.1% in patients with NSI (p = 0.005). Patients with baseline LSI had a DCR of 43.8% at 4 months, compared to 64.2% in patients with NSI (p = 0.017).

Conclusions: LSI was associated with worse OS, PFS, and DCR in GC patients treated with PD-1 inhibitors and might be a quick and efficient biomarker to predict the efficacy of PD-1 inhibitors.

Keywords: Biomarker; Gastric cancer; Immune checkpoint inhibitor; Serum iron.

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Conflict of interest statement

The authors declare that they have no competing interests.

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Comparison of total blood count parameter between low serum iron (LSI) group and normal serum iron (NSI) group. Data shows median values ± quartile. ** p < 0.01, **** p < 0.0001, ns: not significant, NLR: neutrophil-to-lymphocyte ratio
Fig. 2
Fig. 2
(A) The progression-free survival (PFS) curves between low serum iron (LSI) and normal serum iron (NSI) in all 149 gastric cancer patients; (B) the overall survival (OS) curves between LSI and NSI in all 149 gastric cancer patients; (C) the PFS curves between LSI and NSI in 93 patients receiving first-line treatment; (D) the OS curves between LSI and NSI in 93 patients receiving first-line treatment
Fig. 3
Fig. 3
(A) The progression-free survival (PFS) curves between M0–M2– group and M0 + M2 + group in all 149 gastric cancer patients; (B) the overall survival (OS) curves between M0–M2– group and M0 + M2 + group in all 149 gastric cancer patients; (C) the PFS curves between M0–M2– group and M0 + M2 + group in 93 patients receiving first-line treatment; (D) the OS curves between M0–M2– group and M0 + M2 + group in 93 patients receiving first-line treatment (M0: baseline serum iron level; M2: serum iron level at 2 months after PD-1 inhibitor initiation; M0–M2– group: low serum iron at M0 and M2; M0 + M2 + group: normal serum iron at M0 and M2)
See this image and copyright information in PMC

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