Lymphocyte subset is more suitable than systemic inflammatory response biomarker and immunoglobulin in constructing prognostic nomogram model for advanced gastric cancer

Tianyi Fang; Xin Yin; Yufei Wang; Lei Zhang; Yimin Wang; Xinghai Zhang; Xudong Zhao; Xuan Lin; Yingwei Xue

doi:10.1016/j.heliyon.2023.e14669

Lymphocyte subset is more suitable than systemic inflammatory response biomarker and immunoglobulin in constructing prognostic nomogram model for advanced gastric cancer

Heliyon. 2023 Mar 20;9(3):e14669. doi: 10.1016/j.heliyon.2023.e14669. eCollection 2023 Mar.

Authors

Tianyi Fang¹, Xin Yin¹, Yufei Wang¹, Lei Zhang², Yimin Wang¹, Xinghai Zhang², Xudong Zhao², Xuan Lin³, Yingwei Xue¹

Affiliations

¹ Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China.
² Department of Pathology, Harbin Medical University, Harbin, China.
³ Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.

Abstract

The serum factors of inflammation are known to be useful prognostic indicators of gastric cancer (GC). However, few studies have made comparisons to screen out more suitable biomarkers for the construction of Nomogram models. In this study, 566 patients who underwent radical gastrectomy were randomly selected. We evaluated the prognostic value of markers of systemic inflammation, including WBC, NLR, PLR, circulating total T cells, CD4⁺T cells, CD8⁺T cells and CD19⁺B cells, serum IgA, IgM, IgE and IgG, and compared them with traditional tumor markers (CEA, CA19-9, CA72-4 and CA125). Kaplan‒Meier analysis was used to analyze the correlation between biomarkers and overall survival (OS). We used time-dependent ROC analysis to investigate the prognostic accuracy of each biomarker. The risk of death was evaluated by the Cox regression model, and the Nomogram model was constructed by R software. We found that circulating total T cells, CD8⁺T cells, CEA, and CA125 had statistical significance in predicting advanced GC prognosis. Circulating CD8⁺T cells and CA125 were continuously superior to circulating total T cells and CEA in the prediction of 5-year OS. Cox regression found that CA125, circulating CD8⁺T cells, sex, and lymph node metastasis rate were independent risk factors for advanced GC. Furthermore, we combined all these predictors to construct a nomogram, which can supplement the AJCC 8th system. According to the comparison with commonly used serum immune biomarkers, circulating CD8⁺T cells is more sensitive to advanced GC. The prediction function of the Nomogram will supplement the traditional AJCC system, which contributes to individual survival prediction.

Keywords: AJCC 8th staging system; Circulating CD8+T cells; Gastric cancer; Nomogram; Prognosis.