PDF(Pubmed)
Abstract：
BACKGROUND: Assessment of systemic and local immune responses is crucial in determining the efficacy of cancer interventions. The identification of specific factors that correlate with pathological complete response (pCR) is essential for optimizing treatment decisions.
METHODS: In this retrospective study, a total of 521 patients diagnosed with gastric adenocarcinoma who underwent curative gastrectomy following preoperative treatment were reviewed. Of these patients, 463 did not achieve pCR (non-pCR) and 58 achieved pCR. Clinicopathological factors were evaluated to identify predictors for pCR using a logistic regression model. Additionally, a smaller cohort (n=76) was derived using propensity score matching to investigate local immune response, specifically the features of tertiary lymphoid structure (TLS) using H&E staining, immunohistochemistry, and multiplex immunofluorescence.
RESULTS: The multivariate regression analysis demonstrated a significant association between low systemic inflammatory status and pCR, as evidenced by reduced levels of the combined systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) (SII+NLR) (odds ratio: 3.33, 95% CI: 1.79-6.17, P<0.001). In the smaller cohort analysis, distinct TLS characteristics were correlated with the presence of pCR. Specifically, a higher density of TLS and a lower proportion of PD1+ cells and CD8+ cells within TLS in the tumor bed were strongly associated with pCR.
CONCLUSIONS: Both systemic and local immune profile were associated with pCR. A low level of SII+NLR served as an independent predictor of pCR, while distinct TLS features were associated with the presence of pCR. Focusing on the immune profile was crucial for optimal management of gastric cancer patients receiving preoperative treatment.
METHODS: In this retrospective study, a total of 521 patients diagnosed with gastric adenocarcinoma who underwent curative gastrectomy following preoperative treatment were reviewed. Of these patients, 463 did not achieve pCR (non-pCR) and 58 achieved pCR. Clinicopathological factors were evaluated to identify predictors for pCR using a logistic regression model. Additionally, a smaller cohort (n=76) was derived using propensity score matching to investigate local immune response, specifically the features of tertiary lymphoid structure (TLS) using H&E staining, immunohistochemistry, and multiplex immunofluorescence.
RESULTS: The multivariate regression analysis demonstrated a significant association between low systemic inflammatory status and pCR, as evidenced by reduced levels of the combined systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) (SII+NLR) (odds ratio: 3.33, 95% CI: 1.79-6.17, P<0.001). In the smaller cohort analysis, distinct TLS characteristics were correlated with the presence of pCR. Specifically, a higher density of TLS and a lower proportion of PD1+ cells and CD8+ cells within TLS in the tumor bed were strongly associated with pCR.
CONCLUSIONS: Both systemic and local immune profile were associated with pCR. A low level of SII+NLR served as an independent predictor of pCR, while distinct TLS features were associated with the presence of pCR. Focusing on the immune profile was crucial for optimal management of gastric cancer patients receiving preoperative treatment.
摘要：
背景：全身和局部免疫反应的评估对于确定癌症干预的功效至关重要。鉴定与病理完全反应（pCR）相关的特定因素对于优化治疗决策至关重要。
方法：在这项回顾性研究中，共对521例胃腺癌患者进行了回顾性分析,这些患者在术前治疗后接受了根治性胃切除术.在这些病人中,463没有达到pCR（非pCR），58达到pCR。使用逻辑回归模型评估临床病理因素以确定pCR的预测因子。此外,一个较小的队列（n=76）使用倾向评分匹配来研究局部免疫反应，特别是使用H&E染色的三级淋巴结构(TLS)的特征，免疫组织化学，和多重免疫荧光。
结果：多变量回归分析表明，低全身炎症状态与pCR之间存在显着关联，联合全身免疫-炎症指数(SII)和中性粒细胞与淋巴细胞比率(NLR)(SII+NLR)水平降低(比值比:3.33,95%CI:1.79~6.17,P<0.001),证明了这一点.在较小的队列分析中，不同的TLS特征与pCR的存在相关。具体来说,较高的TLS密度和较低比例的TLS内的PD1+细胞和CD8+细胞与pCR密切相关.
结论：全身和局部免疫谱均与pCR相关。低水平的SII+NLR作为pCR的独立预测因子，而不同的TLS特征与pCR的存在相关。关注免疫谱对于接受术前治疗的胃癌患者的最佳管理至关重要。
方法：在这项回顾性研究中，共对521例胃腺癌患者进行了回顾性分析,这些患者在术前治疗后接受了根治性胃切除术.在这些病人中,463没有达到pCR（非pCR），58达到pCR。使用逻辑回归模型评估临床病理因素以确定pCR的预测因子。此外,一个较小的队列（n=76）使用倾向评分匹配来研究局部免疫反应，特别是使用H&E染色的三级淋巴结构(TLS)的特征，免疫组织化学，和多重免疫荧光。
结果：多变量回归分析表明，低全身炎症状态与pCR之间存在显着关联，联合全身免疫-炎症指数(SII)和中性粒细胞与淋巴细胞比率(NLR)(SII+NLR)水平降低(比值比:3.33,95%CI:1.79~6.17,P<0.001),证明了这一点.在较小的队列分析中，不同的TLS特征与pCR的存在相关。具体来说,较高的TLS密度和较低比例的TLS内的PD1+细胞和CD8+细胞与pCR密切相关.
结论：全身和局部免疫谱均与pCR相关。低水平的SII+NLR作为pCR的独立预测因子，而不同的TLS特征与pCR的存在相关。关注免疫谱对于接受术前治疗的胃癌患者的最佳管理至关重要。
