Inflammation‑based prognostic markers in patients with advanced or recurrent gastric cancer treated with nivolumab: Tokushukai REAl‑world Data project 02 (TREAD 02)

Abstract

In addition to blood test data, inflammation-based prognostic markers have been used to predict the prognosis of various types of cancer. However, several of these previous studies may be outdated, as they were conducted prior to the widespread adoption of immune checkpoint inhibitors, leading to limited reports on their efficacy. The present study aimed to assess the accuracy of different inflammation-based prognostic markers in patients with advanced or recurrent gastric cancer undergoing nivolumab monotherapy as salvage-line chemotherapy. In a retrospective cohort study across Japan, a total of 159 patients with advanced or recurrent gastric cancer who were treated with nivolumab between September 2017 and March 2020 were selected. Blood test data were collected within 14 days of the start of chemotherapy and 17 inflammation-based prognostic markers were evaluated. Cox regression analysis was performed using all patient background factors. Subsequently, model selection was performed using backward elimination based on the Akaike information criterion (AIC) to obtain effective background factors which could be assessed for their impact on patient survival. For each marker, the magnitude of the impact on the survival rate, after adjusting for the background factors, was assessed using concordance and AIC analyses. A total of 159 patients (female, 30.2%; median age, 70 years) were included in the present study. Most patients received platinum, fluoropyrimidine and taxane treatment, with a median of three prior lines of systemic therapy. With a median follow-up of 3.3 months (95% CI, 2.5-3.8), median overall survival and time to treatment failure were 3.8 months (95% CI, 3.3-4.5) and 1.8 months (95% CI, 1.8-2.3), respectively. Amongst the 17 markers analyzed, the modified Glasgow prognostic score (mGPS) was classed as the most useful factor that affected the survival rate of patients. Real-world data showed that mGPS, an inflammation-based prognostic marker, had the strongest correlation with prognosis in patients with advanced or recurrent gastric cancer receiving nivolumab monotherapy. The present study was registered as a clinical trial with the UMIN Clinical Trial Registry (http://www.umin.ac.jp/ctr/index.htm) under the trial registration number UMIN000050590 on 15th March 2023.

Keywords: gastric cancer; inflammation-based prognostic markers; nivolumab; real-world data.

Figure 1

Flow chart of the patient recruitment and enrollment process in the present study. W, weeks.

Figure 2

Kaplan-Meier curves. (A) overall survival and (B) and time to treatment failure.

Figure 3

OS based on different scores and ratios. A log-rank test was used to calculate statistical significance. (A) PNI, (B) GPS, (C) mGPS, (D) CAR, (E) NLR, (F) PLR, (G) LMR, (H) dNLR, (I) NPS, (J) NLS, (K) PLS, (L) LMS, (M) PI, (N) SII, (O) SIRI, (P) LIPI and (Q) CALLY. CRP, C-reactive protein, df; degrees of freedom; OS, overall survival; PNI, prognostic nutritional index; GPS, Glasgow prognostic score; mGPS, modified GPS; CAR, CRP-to-albumin ratio; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; LMR, lymphocyte-to-monocyte ratio; dNLR, derived NLR; NPS, neutrophil-platelet score; NLS, neutrophil-lymphocyte score; PLS, platelet-lymphocyte score; LMS, lymphocyte-monocyte score; PI, prognostic index; SII, systemic immune-inflammation index; SIRI, systemic inflammation response index; LIPI, lung immune prognostic index; CALLY, CRP albumin lymphocyte index.