Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2025; 17(3): 100927
Published online Mar 15, 2025. doi: 10.4251/wjgo.v17.i3.100927
Hypercoagulation after neoadjuvant immunochemotherapy as a new prognostic indicator in patients with locally advanced gastric cancer undergoing surgery
Tian-Hao Li, Xiong Sun, Cheng-Guo Li, Yu-Ping Yin, Kai-Xiong Tao
Tian-Hao Li, Xiong Sun, Cheng-Guo Li, Yu-Ping Yin, Kai-Xiong Tao, Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Co-first authors: Tian-Hao Li and Xiong Sun.
Co-corresponding authors: Yu-Ping Yin and Kai-Xiong Tao.
Author contributions: Yin YP and Tao KX had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis; Li TH, Sun X and Li CG participated in the acquisition, analysis, and interpretation of data; Li TH drafted the manuscript. All authors critically reviewed and provided final approval of the manuscript; all authors were responsible for the decision to submit the manuscript for publication. Li TH, Sun X and Yin YP contributed to the concept and design of this study. Here is the rationale for designating two as co-corresponding authors. This manuscript has been assigned two co-corresponding authors in recognition of their equally vital contributions to the research. Dr. Yin YP provided strategic direction and data support, while Dr. Tao KX secured the necessary funding and led the research initiative. Both researchers were equally involved in every aspect of the study, from conceptualization to implementation. It is only fitting to acknowledge their joint efforts by naming them as co-corresponding authors. Together, they are also entrusted with ensuring the precision and completeness of the research, which facilitates more effective oversight and management of the publication process. Consequently, we have chosen to list them as co-corresponding authors.
Supported by Natural Science Foundation of Hubei Province of China, No. 2024AFB655; Key Research and Development Program of Hubei Province of China, No. 2021BCA116; and National Natural Science Foundation of China, No. 82072736, No. 82003205, No. 82373123 and No. 82473175.
Institutional review board statement: This investigation was approved by the Institutional Ethics Committee of Wuhan Union Hospital, No. 2020-0447.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no potential conflicts of interest to declare.
Data sharing statement: No additional data are available.
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: Yu-Ping Yin, MD, PhD, Doctor, Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. yinyuping2017@hust.edu.cn
Received: August 30, 2024
Revised: December 6, 2024
Accepted: December 25, 2024
Published online: March 15, 2025
Processing time: 167 Days and 23.2 Hours
Abstract
BACKGROUND

Coagulation status is closely related to the progression of malignant tumors. In the era of neoadjuvant immunochemotherapy (NICT), the prognostic utility of coagulation indicators in patients with locally advanced gastric cancer (LAGC) undergoing new treatments remains to be determined.

AIM

To determine whether hypercoagulation is an effective prognostic indicator in patients with LAGC who underwent radical resection after NICT.

METHODS

A retrospective analysis of clinical data from 104 patients with LAGC, who underwent radical resection after NICT between 2020 and 2023, was performed. D-dimer and fibrinogen concentrations were measured one week before NICT, and again one week before surgery, to analyze the association between these two indicators and their combined indices [non-hypercoagulation (D-dimer and fibrinogen concentrations within the upper limit of normal) vs hypercoagulation (D-dimer or fibrinogen concentrations above the upper limit of normal)] with prognosis. After radical resection, patients were followed-up periodically. The median follow-up duration was 21 months.

RESULTS

Data collected after NICT revealed that the three-year overall survival (OS) and disease-free survival (DFS) rates the non-hypercoagulation group were significantly better than those in the hypercoagulation group [94.4% vs 78.0% (P = 0.019) and 87.0% vs 68.0% (P = 0.027), respectively]. Multivariate analysis indicated that hypercoagulation after NICT was an independent factor for poor postoperative OS [hazard ratio (HR) 4.436, P = 0.023] and DFS (HR 2.551, P = 0.039). Pre-NICT data demonstrated no statistically significant difference in three-year OS between the non-hypercoagulation and hypercoagulation groups (88.3% vs 84.1%, respectively; P = 0.443).

CONCLUSION

Hypercoagulation after NICT is an effective prognostic indicator in patients with LAGC undergoing radical gastrectomy.

Keywords: Locally advanced gastric cancer; Coagulation; Neoadjuvant immunochemotherapy; Prognosis; Radical gastrectomy

Core Tip: This retrospective study assessed the correlation between hypercoagulation after neoadjuvant immunochemotherapy (NICT) and the prognosis of patients with locally advanced gastric cancer (LAGC). Results indicated that the non-hypercoagulation group exhibited significantly superior overall survival (OS) and disease-free survival (DFS) rates compared with the hypercoagulation group. Furthermore, multivariate analysis revealed that hypercoagulation after NICT was an independent risk factor for adverse postoperative OS and DFS. This suggests that hypercoagulation after NICT is an independent prognostic indicator of LAGC and may be used to evaluate therapeutic effects.