Clinical Value Of Inflammatory Markers In Monitoring The Efficacy And Assessing The Prognosis Of Patients With Advanced Gastric Cancer Treated With PD-1 Inhibitors

Background and purpose This clinical study sought to determine the clinical value of inflammatory marker levels in patients with advanced gastric cancer treated with programmed death protein-1(PD-1)inhibitors.To investigate whether inflammatory markers can be used as biomarkers for efficacy monitoring and prognostic assessment in patients with advanced gastric cancer receiving immunotherapy with PD-1 inhibitors,and to facilitate better implementation of individualized gastric cancer therapy.Methods Using peripheral blood samples and baseline clinicopathological characteristics of patients with gastric cancer,we investigated the specific value of inflammatory markers in patients with advanced gastric cancer from the clinical perspective of immunotherapy with PD-1 inhibitors.Results From July 20,2019 to March 16,2021,a total of 106 patients with advanced gastric cancer treated with PD-1 inhibitors were enrolled in this study.A significant decrease in NLR,d NLR,and SII was noticed among the PR(P=0.023;P=0.036;P=0.001),SD(P=0.048;P=0.022;P=0.023),ORR(P=0.021;P=0.032;P=0.001),and DCR(P=0.003;P=0.001;P<0.001)groups after PD-1 inhibitor therapy.In addition,PLR levels were similarly significantly decreased in the PR group(P=0.010),ORR group(P=0.007)and DCR group(P=0.005)after PD-1 inhibitor treatment.Compared with baseline levels,only MLR level was significantly increased when PD-1 inhibitor therapy failed(P=0.039).And statistically significant elevations in NLR(P=0.001),MLR(P=0.020),d NLR(P=0.002),and SII(P=0.019)were found in failure of PD-1inhibitor treatment compared to optimal efficacy in advanced gastric cancer patients.In first-line treatment,the number of metastatic sites(P=0.001)was an independent prognostic factor for PFS,and peritoneal metastases(P=0.004)and platelet to lymphocyte ratio(PLR)level(P=0.014)were independent prognostic predictors of OS according to Cox regression analysis.In second-line or post-line treatment,the number of metastatic sites(P=0.007),ECOG PS(P=0.011)and PLR level(P=0.033)were independent prognostic factors for PFS in patients with advanced gastric cancer according to Cox regression analysis,while the number of metastatic sites(P=0.003),degree of tumor differentiation(P=0.030)and NLR level(P< 0.001)were independent prognostic factors for OS.Conclusions NLR,PLR,MLR,d NLR and SII levels reflect the short-term efficacy of immunotherapy in patients with advanced gastric cancer treated with PD-1 inhibitors.PLR level is an independent prognostic factor for OS in AGC patients receiving first-line immunotherapy and PFS in those receiving second-line or post-line immunotherapy.And NLR level was an independent prognostic factor for OS in patients with advanced gastric cancer receiving second-or post-line immunotherapy.Besides,the number of metastatic sites was significantly associated with the prognosis of advanced gastric cancer patients receiving immunotherapy.