Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2024; 30(24): 3059-3075
Published online Jun 28, 2024. doi: 10.3748/wjg.v30.i24.3059
Development and validation of a prognostic immunoinflammatory index for patients with gastric cancer
Zhi-Chang Ba, Xi-Qing Zhu, Zhi-Guo Li, Yuan-Zhou Li
Zhi-Chang Ba, Yuan-Zhou Li, Department of Radiology, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
Zhi-Chang Ba, Xi-Qing Zhu, Zhi-Chang Ba and Xi-Qing Zhu.
Xi-Qing Zhu, Zhi-Guo Li, Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
Author contributions: Ba ZX and Zhu XQ contributed equally to this work; Ba ZC contributed to writing of the original draft and review & editing of the manuscript; Ba ZC and Zhu XQ contributed to data curation and investigation; Zhu XQ contributed to methodology and supervision; Li ZG and Li YZ contributed to resources, funding acquisition, and project administration.
Supported by Clinical Research Foundation of Jie-Ping Wu Medical Foundation, No. 320.6750.2022-07-13.
Institutional review board statement: This study was approved by the Ethics Committee of Harbin Medical University Cancer Hospital (No. 2019-57-IIT).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The material supporting the conclusion of this article has been included within the article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuan-Zhou Li, PhD, Professor, Department of Radiology, Harbin Medical University Cancer Hospital, No. 150 Haping Road, Nangang District, Harbin 150081, Heilongjiang Province, China. 830667@hrbmu.edu.cn
Received: April 5, 2024
Revised: May 22, 2024
Accepted: May 29, 2024
Published online: June 28, 2024
Processing time: 81 Days and 8.3 Hours
Abstract
BACKGROUND

Studies have demonstrated the influence of immunity and inflammation on the development of tumors. Although single biomarkers of immunity and inflammation have been shown to be clinically predictive, the use of biomarkers integrating both to predict prognosis in patients with gastric cancer remains to be investigated.

AIM

To investigate the prognostic and clinical significance of inflammatory biomarkers and lymphocytes in patients undergoing surgical treatment for gastric cancer.

METHODS

Univariate COX regression analysis was performed to identify potential prognostic factors for patients with gastric cancer undergoing surgical treatment. Least absolute shrinkage and selection operator-COX (LASSO-COX) regression analysis was performed to integrate these factors and formulate a new prognostic immunoinflammatory index (PII). The correlation between PII and clinical characteristics was statistically analyzed. Nomograms incorporating the PII score were devised and validated based on the time-dependent area under the curve and decision curve analysis.

RESULTS

Patients exhibiting elevated neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune inflammatory index displayed inferior progression-free survival (PFS) and overall survival (OS). Conversely, low levels of CD3(+), CD3(+) CD8(+), CD4(+)CD8(+), and CD3(+)CD16(+)CD56(+) T lymphocytes were associated with improved PFS and OS, while high CD19(+) T lymphocyte levels were linked to worse PFS and OS. The PII score demonstrated associations with tumor characteristics (primary tumor site and tumor size), establishing itself as an independent prognostic factor for both PFS and OS. Time-dependent area under the curve and decision curve analysis affirmed the effectiveness of the PII-based nomogram as a robust prognostic predictive model.

CONCLUSION

PII may be a reliable predictor of prognosis in patients with gastric cancer undergoing surgical treatment, and it offers insights into cancer-related immune-inflammatory responses, with potential significance in clinical practice.

Keywords: Gastric cancer, Immunity, Inflammation, Prognosis, Nomogram

Core Tip: We conducted a retrospective study in which data for lymphocyte subsets and blood inflammatory markers were collected from 291 patients who underwent surgical treatment for gastric cancer. Least absolute shrinkage and selection operator-COX regression analysis was used to construct a new immune-inflammatory biomarker. Internal validation divided into training and validation sets confirmed that patients with higher prognostic immunoinflammatory index scores had a worse prognosis.