Higher Post-Operative Plasma EV PD-L1 Predicts Poor Survival in Gastric Cancer Patients

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Background: The satisfactory prognostic indicator of gastric cancer patients after surgery is still lacking. Peri-operative plasma extracellular vesicular (EV) PD-L1 has been demonstrated as a potential prognosis biomarker in many types of cancers. The prognostic value of post-operative plasma EV PD-L1 has not been characterized. Methods: We evaluated the prognostic value of pre-operative, post-operative and change in plasma EV PD-L1, as well as plasma soluble PD-L1, in short-term survival of gastric cancer patients after surgery. The Kaplan-Meier survival model and Cox proportional hazards models for both univariate and multivariate analyses were used. Findings: The prognostic value of post-operative EV PD-L1 is superior to that of pre-operative EV PD-L1 on gastric cancer patients after resection. The levels of post-operative EV PD-L1 and EV PD-L1 change are independent prognostic factors for overall survival and recurrence free survival of gastric cancer patients. High plasma level of post-operative ePD-L1 correlates significantly with poor survival, while high change in ePD-L1 level brings the significant survival benefit. Interpretation: The level of plasma post-operative EV PD-L1 could be considered as a prognostic biomarker of GC patients after resection. Funding Statement: This work was supported by following foundations: (a). National Natural Science Foundation of China (No. 30901821, 81172136, 82072737, 81201810). (b). Natural Science Foundation of Shanxi (No. 201701D121165, 201901D111190). (c). Research Project Supported by Shanxi Scholarship Council of China(No. 2020-194). (d). International Science and Technology Cooperation Project of Shanxi Provincial Key R&D Program (No. 201703D421023). (e). Shanxi Youth Science and Technology Research Fund (No. 201801D221069). (f). Open Fund from Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, China (No. KLMEC/SXMU202011). (g). Shanxi “1331 Project” Key Subjects Construction (No. 1331KSC). (h). Shanxi Province Science Foundation for Distinguished Young Scholar (No. 201901D211547). (i). Science and Research Fund of Shanxi Health Commission(No. 2019059). (j). the Doctor Project of Shanxi Cancer Hospital, China (No. 2017A06). (k). the Key Research Project of Shanxi Province, China (No. 201703D321010-1). (l). Natural Science Foundation of Guangdong Province, China (No. 2015A030313057). Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: All subjects had provided written informed consent. This study was approved by Shanxi Cancer Hospital Ethics Committee.