Inflammatory Markers Predict Survival in Patients With Advanced Gastric and Colorectal Cancers Receiving Anti-PD-1 Therapy

Xiaona Fan; Dan Wang; Wenjing Zhang; Jinshuang Liu; Chao Liu; Qingwei Li; Zhigang Ma; Hengzhen Li; Xin Guan; Yibing Bai; Jiani Yang; Changjie Lou; Xiaobo Li; Guangyu Wang; Zhiwei Li

doi:10.3389/fcell.2021.638312

Inflammatory Markers Predict Survival in Patients With Advanced Gastric and Colorectal Cancers Receiving Anti-PD-1 Therapy

Front Cell Dev Biol. 2021 Mar 15:9:638312. doi: 10.3389/fcell.2021.638312. eCollection 2021.

Authors

Xiaona Fan¹, Dan Wang¹, Wenjing Zhang¹, Jinshuang Liu^{1

2}, Chao Liu¹, Qingwei Li¹, Zhigang Ma¹, Hengzhen Li¹, Xin Guan^{1

2}, Yibing Bai¹, Jiani Yang¹, Changjie Lou¹, Xiaobo Li¹, Guangyu Wang¹, Zhiwei Li¹

Affiliations

¹ Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
² Translational Medicine Research and Cooperation Center of Northern China, Heilongjiang Academy of Medical Sciences, Harbin, China.

Abstract

There is a lack of useful biomarkers for predicting the efficacy of anti-programmed death-1 (PD-1) therapy for advanced gastric and colorectal cancer. To address this issue, in this study we investigated the correlation between inflammatory marker expression and survival in patients with advanced gastric and colorectal cancer. Data for 111 patients with advanced gastric and colorectal cancer treated with anti-PD-1 regimens were retrospectively analyzed. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and clinical characteristics of each patient were selected as the main variables. Overall response rate, disease control rate, and progression-free survival were primary endpoints, and overall survival and immune-related adverse events (irAEs) were secondary endpoints. The chi-squared test and Fisher's exact test were used to evaluate relationships between categorical variables. Uni- and multivariate Cox regression analyses were performed, and median progression-free survival and overall survival were estimated with the Kaplan-Meier method. The overall response rate and disease control rate of anti-PD-1therapy in advanced gastric and colorectal tumors were 12.61 and 66.66%, respectively. The patients with MLR < 0.31, NLR < 5, and PLR < 135 had a significantly higher disease control rate than those with MLR > 0.31, NLR > 5, and PLR > 135 (P < 0.05). The multivariate analysis revealed that MLR < 0.31, BMI > 18.5, and anti-PD-1 therapy in first-line were associated with prolonged PFS. MLR < 0.31 and BMI > 18.5 were associated with prolonged overall survival. The irAE rate differed significantly between PLR groups, and PLR < 135 was associated with an increased rate of irAEs (P = 0.028). These results indicate that the inflammatory markers NLR, MLR, and PLR have clinical utility for predicting survival or risk of irAEs in patients with advanced gastric cancer and colorectal cancer.

Keywords: PFS; advanced gastric and colorectal cancer; anti–PD-1 therapy; inflammatory biomarker; response.