Abstract
Programmed cell death 1 (PD1) inhibitors have shown promising treatment effects in advanced gastric cancer, the beneficiary population not definite. This study aimed to construct an individualized radiomics model to predict the treatment benefits of PD-1 inhibitors in gastric cancer. Patients with advanced gastric cancer treated with PD-1 inhibitors were randomly divided into a training set (n = 58) and a validation set (n = 29). CT imaging data were extracted from medical records, and an individual radiomics nomogram was generated based on the imaging features and clinicopathological risk factors. Discrimination performance was evaluated by Harrell’s c-index and receiver operator characteristic (ROC) curve analyses. The areas under the ROC curves (AUCs) were analyzed to predict anti-PD-1 efficacy and survival. We found that the radiomics nomogram could predict the response of gastric cancer to anti-PD-1 treatment. The AUC was 0.865 with a 95% CI of 0.812-0.828 in the training set, while the AUC was 0.778 with a 95% CI of 0.732–0.776 in the validation set. The diagnostic performance of the radiomics was significantly higher than that of the clinical factors (p < 0.01). Patients with a low risk of disease progression discriminated by the radiomics nomogram had longer progression-free survival than those with a high risk (6.5 vs. 3.2 months, HR 1.99, 95% CI: 1.19-3.31, p = 0.009). The radiomics nomogram based on CT imaging features and clinical risk factors could predict the treatment benefits of PD-1 inhibitors in advanced gastric cancer, enabling it to guide decision-making regarding clinical treatment.
Highlights
Gastric cancer is the third most common life-threatening malignancy
All enrolled patients were treated with progressive disease (PD)-1 inhibitors after first-line standard chemotherapy, and enrolled patients were divided into a training set (n = 58) and a validation set (n = 29) (Figure 1)
Every patient in the cohort was classified as a PD responder or non-PD responder according to the treatment efficacy
Summary
Gastric cancer is the third most common life-threatening malignancy. The molecular and biological features of gastric cancers vary from one genetic subtype to another, affecting the sensitivity and response of cancers to conventional chemotherapy and single-molecule targeted therapy [2, 3]. Recent studies on immunotherapy have advanced our traditional concepts and tumor treatment approaches. Immune checkpoint inhibitors (ICIs) targeting the PD1/PDL1 axis have shown breakthrough efficacy in a variety of solid tumors, including advanced gastric cancer resistant to chemotherapy after multi-course treatment [3, 4]. Since 2017, anti-PD1 monoclonal www.aging-us.com antibody has been approved for second-line treatment of advanced gastric cancer. Anti-PD1 agents has been approved for first-line treatment of advanced gastric cancer in the whole population [5]
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