Prognostic analysis of stage III gastric cancer after curative surgery according to the newest TNM classification

Stromal score is a promising index in tumor patients' outcome determination

Background

Immune status is widely acknowledged as a valuable marker for predicting cancer prognosis and therapy response. However, there has been a limited understanding of the stromal landscape in cancer.

Methods

By employing ESTIMATE, stromal- and immune-scores were inferred for 6193 tumor samples spanning 12 cancer types sourced from The Cancer Genome Atlas (TCGA). Subsequently, the samples were categorized into seven groups based on their stromal and immune scores. A comparison of prognosis, lymphocyte and stromal cell infiltration, and the response to programmed death ligand 1 (PD-L1) therapy was conducted among these subtypes.

Results

It was unveiled by the analysis that, in the majority of cancer types, stromal score exhibited a more potent predictive capability for outcomes compared to the immune score. Furthermore, it was observed that in four cancer types, intermediate immune infiltration coupled with low stromal infiltration correlated with the most favorable overall survival, whereas an unfavorable outcome was predicted in colorectal cancer (CRC) and stomach adenocarcinoma (STAD) when high immune infiltration coexisted with intermediate or high stromal infiltration.

Conclusion

In summary, while high immune scores frequently correlate with a positive prognosis, such correlation is not universal. A potential strategy to address the current limitations of the immune score in specific circumstances could involve a focus on stromal scores or a subtle integration of stromal and immune status.

Cortactin and HER2 as potential markers for dural-targeted therapy in advanced gastric cancer

To study the role of HER2/cortactin co-overexpression in advanced gastric cancer (GC). This study retrospectively enrolled 246 patients with stage III GC from January 2015 to December 2016 at our hospital. We explored, using immunostaining techniques, the role of the expression of cortactin and HER2 in the progression of advanced GC. The patient data, including age, sex, cortactin and HER2 expression, pathological parameters and survival, were collected. Univariate and multivariate analyses were used to analyze the characteristics, survival, and prognostic factors of the patients. The results showed that the expression of cortactin was significantly associated with vascular-lymphatic invasion (P < 0.001), N stage (P = 0.001), and TNM stage (P = 0.046). HER2 overexpression correlated with tumor size (P = 0.002), neural invasion (P = 0.002), Lauren classification (P = 0.005) and N stage (P = 0.034). Through univariate analysis using the Kaplan-Meier method, vascular-lymphatic invasion (P = 0.015), neural invasion (P = 0.021), N stage (P < 0.003), and HER2/cortactin co-overexpression (P < 0.028) were shown to be significantly associated with overall survival. Multivariate analysis demonstrated that vascular lymphatic invasion (hazard ratio = 1.481, 95% CI, 1.064 to 2.061, P = 0.020), neural invasion (hazard ratio = 1.505, 95% CI, 1.084 to 2.089, P = 0.015), N stage (N2/N1: hazard ratio = 1.655, 95% CI, 1.048 to 2.641, P < 0.031, N3/N1: hazard ratio = 2.089, 95% CI, 1.325 to 3.295, P < 0.002), and HER2/cortactin co-overexpression (hazard ratio = 1.427, 95% CI, 1.007 to 2.024, P = 0.046) were independent prognostic factors for poor overall survival. The results suggested that HER2/cortactin co-overexpression is an important predictive biomarker for GC patients. GC patients with HER2/cortactin co-overexpression may receive dual-targeted therapy to improve survival prognosis in the future.

A Novel Inflammatory-Nutritional Prognostic Scoring System for Stage III Gastric Cancer Patients With Radical Gastrectomy Followed by Adjuvant Chemotherapy

Purpose

The present study was designed to explore the prognostic value of preoperative inflammatory and nutritional biomarkers in stage III gastric cancer (GC) patients with adjuvant chemotherapy and to develop a novel scoring system called the inflammatory-nutritional prognostic score (INPS).

Methods

A total of 513 patients with pathological stage III GC undergoing radical gastrectomy followed by adjuvant chemotherapy from 2010 to 2017 were enrolled in the study. Clinicopathological characteristics and blood test parameters of individual patients were collected. The least absolute shrinkage and selection operator (LASSO) Cox regression model was used for feature selection to construct INPS. Survival curves were generated using the Kaplan-Meier method with log-rank tests. The nomogram was generated based on the result of the multivariate analysis using Cox's proportional hazards model. The model was assessed by the concordance index (C-index) and was internally validated by bootstraps.

Results

According to the results of Lasso Cox regression and K-M survival curves, INPS was determined as follows: a low body mass index (BMI) (<23 kg/m²), a low prealbumin (<180 mg/L), a high neutrophil-lymphocyte ratio (NLR) (≥2.7), a high platelet-lymphocyte ratio (PLR) (≥209.4), a low lymphocyte-monocyte ratio (LMR) (<2.8), and a low prognostic nutritional index (PNI) (<45.1); each were scored as 1, and the remaining values were scored as 0. The individual scores were then summed up to construct the INPS and further divided into 4 groups: Low Risk (INPS 0); Low-medium Risk (INPS 1); High-medium Risk (INPS 2-4); and High Risk (INPS 5-6). In multivariate analysis, INPS was an independent predictor of overall survival (OS) in stage III GC, with the 5-year OS rates of 70.8%, 57.4%, 41.5%, and 30.6%, respectively. The nomogram based on INPS and other independent predictors (gender, pT stage, pN stage, lymphovascular invasion, and CEA level) showed good predicting performance with a C-index of 0.707, which was superior to the TNM stage alone (C-index 0.645, p=0.008) and was internally validated with the corrected C-index of 0.693.

Conclusion

Preoperative INPS was an independent prognostic factor of stage III GC patients with radical surgery followed by adjuvant chemotherapy. The nomogram based on INPS may serve as a simple and potential model in risk stratification and guiding treatment strategies in clinical practice.

Diagnostic and prognostic value of the peripheral natural killer cell levels in gastric cancer

Peripheral blood lymphocyte subsets have been reported to be useful as prognostic and/or diagnostic markers for patients with cancer. However, the clinical value of peripheral blood lymphocyte subsets in gastric cancer (GC) has remained elusive. In the present study, peripheral CD3⁺, CD4⁺ and CD8⁺ T lymphocytes, B cells (CD19⁺), regulatory T cells (Tregs; CD4⁺CD25⁺CD127^-) and natural killer (NK) cells (CD3^-CDl6⁺CD56⁺) were detected by flow cytometry in 122 patients with GC, 80 healthy donors (HDs) and 80 patients with gastric ulcer (GU). NK cells (CD56⁺) were detected by immunohistochemical (IHC) analysis in 20 GC and three GU tissue samples. A receiver-operating characteristic (ROC) curve was used to determine the threshold of the peripheral NK cell level and survival analysis was performed to assess its prognostic value in patients with GC. The results indicated that the peripheral NK cell proportion in patients with GC (18.77%) was significantly higher than that in the HD (12.19%) and GU (12.74%) groups. IHC analysis suggested that the NK level in GC tumor samples was correlated with that in paired serum samples. ROC curve analysis indicated that the peripheral NK cell level (15.16%) was able to effectively identify patients with GC, a diagnostic sensitivity of 75.41% and a specificity of 77.45% were determined. Multivariate logistic regression analysis revealed that the peripheral NK cell level was independently associated with the T stage and survival analysis demonstrated that high levels of peripheral NK cells were associated with poor prognosis of patients with GC. In conclusion, the peripheral NK cell level may be a diagnostic and prognostic marker for patients with GC.