Abstract
Background Substantial evidence has demonstrated that tumor-infiltrating lymphocytes (TILs) are correlated with patient prognosis. The TIL-based immune score (IS) affects prognosis in various cancers, but its prognostic impact in gastric cancer (GC) patients treated with adjuvant chemoradiotherapy remains unclear. Methods A total of 101 GC patients who received chemoradiotherapy after gastrectomy were retrospectively analyzed in this study. Immunohistochemistry staining for CD3+ and CD8+ T-cell counts in both tumor center (CT) and invasive margin (IM) regions was built into the IS. Patients were then divided into three groups based on their differential IS levels. The correlation between IS and clinical parameters was analyzed. The prognostic impact of IS and clinical parameters was evaluated using Kaplan–Meier analysis and Cox proportional hazard regression analysis. Receiver operating characteristic (ROC) curves were plotted to compare the area under the curve (AUC) of IS with other clinical parameters. Nomograms for disease-free survival (DFS) and overall survival (OS) prediction were constructed based on the identified parameters. Results Finally, 20 (19.8%), 57 (56.4%), and 24 (23.8%) GC patients were identified with low, intermediate, and high IS levels, respectively. GC patients with higher IS levels exhibited better DFS (p < 0.001) and OS (p < 0.001). IS was an independent prognostic factor for both DFS (p < 0.001) and OS (p < 0.001) in multivariate analysis. IS presented a better predictive ability than the traditional pathological tumor-node-metastasis (pTNM) staging system (AUC: 0.801 vs. 0.677 and 0.800 vs. 0.660, respectively) with respect to both DFS and OS. The C-index of the nomograms for DFS and OS prediction was 0.737 and 0.774, respectively. Conclusions IS is a strong predictive factor for both DFS and OS in GC patients treated with adjuvant chemoradiotherapy, which may complement the traditional pTNM staging system.
Highlights
Gastric cancer (GC) is the fifth most common malignant tumor with the third highest mortality rate worldwide [1]
101 gastric cancer (GC) patients who received adjuvant chemoradiotherapy were included in our study. ey had good performance status (ECOG 0–1) with 61.4% presenting Eastern Cooperative Oncology Group (ECOG) 0
Borrmann type III (65.3%), poor differentiation grade (66.3%), lymphatic and vascular invasion (LVI) positivity (62.4%), and perineural invasion (PNI) positivity (61.4%) were the most commonly observed characteristics (Supplementary Table 1). e median follow-up time was 73.7 months, and 58 relapses and 58 deaths occurred during this period
Summary
Gastric cancer (GC) is the fifth most common malignant tumor with the third highest mortality rate worldwide [1]. Tumor-infiltrating lymphocytes (TILs), key components in the TME, have been shown to be strongly correlated with patient prognosis in various cancers [10,11,12,13]. Galon et al. Substantial evidence has demonstrated that tumor-infiltrating lymphocytes (TILs) are correlated with patient prognosis. E TIL-based immune score (IS) affects prognosis in various cancers, but its prognostic impact in gastric cancer (GC) patients treated with adjuvant chemoradiotherapy remains unclear. IS presented a better predictive ability than the traditional pathological tumor-node-metastasis (pTNM) staging system (AUC: 0.801 vs 0.677 and 0.800 vs 0.660, respectively) with respect to both DFS and OS. IS is a strong predictive factor for both DFS and OS in GC patients treated with adjuvant chemoradiotherapy, which may complement the traditional pTNM staging system
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