Prognostic Impact of Sarcopenia and Radiotherapy in Patients With Advanced Gastric Cancer Treated With Anti-PD-1 Antibody
- Authors
- Kim, N[Kim, Nalee]; Yu, JI[Yu, Jeong Il]; Lim, DH[Lim, Do Hoon]; Lee, J[Lee, Jeeyun]; Kim, ST[Kim, Seung Tae]; Hong, JY[Hong, Jung Yong]; Kang, WK[Kang, Won Ki]; Jeong, WK[Jeong, Woo Kyoung]; Kim, KM[Kim, Kyoung-Mee]
- Issue Date
- 8-Jul-2021
- Publisher
- FRONTIERS MEDIA SA
- Keywords
- gastric cancer; immunotherapy; radiation therapy; sarcopenia; inflammation; prognosis
- Citation
- FRONTIERS IN IMMUNOLOGY, v.12
- Indexed
- SCIE
SCOPUS
- Journal Title
- FRONTIERS IN IMMUNOLOGY
- Volume
- 12
- URI
- https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/89392
- DOI
- 10.3389/fimmu.2021.701668
- ISSN
- 1664-3224
- Abstract
- Background We explored the combined effects of sarcopenia (SAR) and radiotherapy (RT) on outcomes in patients with advanced gastric cancer (AGC) treated with immune-checkpoint blockade (ICB). Methods Among 185 patients with AGC treated with ICB, we defined SAR as skeletal muscle index <49 cm2/m2 for men and <31 cm2/m2 for women; 93 patients met criteria. We defined high neutrophil-to-lymphocyte ratio (hNLR) as NLR >= 3. Palliative RT was performed in 37 patients (20%) before ICB. Results We frequently observed hNLR in patients with SAR (53% vs. 35%, p = 0.02). The median overall survival (OS) for the entire cohort was 5 months. Stratification by risk factors of SAR or hNLR revealed a significant difference in median OS (0 [N = 60] vs. 1 [N = 76] vs. 2 [N = 49]: 7.6 vs. 6.4 vs. 2.2 months, p < 0.001). Patients with microsatellite instability-high (MSI-H, N = 19) or Epstein-Barr virus (EBV)-positive tumors (N = 13) showed favorable outcomes compared to those with microsatellite stable (MSS, N = 142) tumors (median OS, not reached vs. 16.8 vs. 3.8 months, respectively). The benefit of RT was evident in patients with both SAR and hNLR (median OS, 3.1 vs. 1.3 months, p = 0.02) and MSS/EBV-negative tumor (median OS, 6.5 vs. 3.5 months, p = 0.03), but outcomes after RT in MSI-H tumor were not significantly different. In multivariable analysis, SAR/hNLR, molecular subtypes, and a history of RT were associated with OS (all p < 0.05). Conclusions We demonstrated the negative predictive value of SAR/hNLR on outcomes after ICB for AGC, and the history of RT could overcome the negative impact of SAR/hNLR and the MSS/EBV-negative subtype.
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Collections - Medicine > Department of Medicine > 1. Journal Articles
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