Abstract：
BACKGROUND: We aimed to investigate clinicopathologic factors leading to different clinical outcomes in patients with deficient mismatch repair protein (d-MMR) gastric cancer (GC) treated with nivolumab plus chemotherapy (nivolumab chemotherapy).
METHODS: This retrospective study included 28 patients with d-MMR advanced GC treated with first-line nivolumab chemotherapy. As a control group, 68 treated with first-line chemotherapy alone were included. Clinicopathological factors, including the neutrophil-to-lymphocyte ratio (NLR) and PD-L1 combined positive score (CPS), were analyzed with regards to the efficacy outcomes.
RESULTS: Progression-free survival (PFS) was longer (median PFS; not reached [NR] vs. 5.2 months, hazard ratio [HR] 0.28, P < 0.001), and overall survival (OS) tended to be longer (median OS; NR vs. 17.9 months, HR 0.43, P = 0.057) in patients treated with nivolumab chemotherapy than those treated with chemotherapy. The PFS benefit of nivolumab chemotherapy over chemotherapy was pronounced in the subgroup with a lower NLR (< 3.80 [median NLR]) (HR 0.10), whereas it was less prominent in patients with a high NLR (≥ 3.80) (HR 0.58). Among patients treated with nivolumab chemotherapy, PFS was worse in patients with a higher NLR (≥ 3.80) than in those with a lower NLR (< 3.80), and survival outcomes were similar between those with PD-L1 CPS ≥ 5 and < 5.
CONCLUSIONS: Nivolumab chemotherapy was associated with better efficacy outcomes than chemotherapy alone among patients with d-MMR GC, but survival outcomes were poor even with nivolumab chemotherapy for those with a high NLR. Survival outcomes were not different according to PD-L1 CPS among d-MMR patients treated with nivolumab chemotherapy.
METHODS: This retrospective study included 28 patients with d-MMR advanced GC treated with first-line nivolumab chemotherapy. As a control group, 68 treated with first-line chemotherapy alone were included. Clinicopathological factors, including the neutrophil-to-lymphocyte ratio (NLR) and PD-L1 combined positive score (CPS), were analyzed with regards to the efficacy outcomes.
RESULTS: Progression-free survival (PFS) was longer (median PFS; not reached [NR] vs. 5.2 months, hazard ratio [HR] 0.28, P < 0.001), and overall survival (OS) tended to be longer (median OS; NR vs. 17.9 months, HR 0.43, P = 0.057) in patients treated with nivolumab chemotherapy than those treated with chemotherapy. The PFS benefit of nivolumab chemotherapy over chemotherapy was pronounced in the subgroup with a lower NLR (< 3.80 [median NLR]) (HR 0.10), whereas it was less prominent in patients with a high NLR (≥ 3.80) (HR 0.58). Among patients treated with nivolumab chemotherapy, PFS was worse in patients with a higher NLR (≥ 3.80) than in those with a lower NLR (< 3.80), and survival outcomes were similar between those with PD-L1 CPS ≥ 5 and < 5.
CONCLUSIONS: Nivolumab chemotherapy was associated with better efficacy outcomes than chemotherapy alone among patients with d-MMR GC, but survival outcomes were poor even with nivolumab chemotherapy for those with a high NLR. Survival outcomes were not different according to PD-L1 CPS among d-MMR patients treated with nivolumab chemotherapy.
摘要：
背景：我们旨在研究导致错配修复蛋白缺失（d-MMR）胃癌（GC）患者接受纳武单抗联合化疗（纳武单抗化疗）的不同临床结局的临床病理因素。
方法：这项回顾性研究包括28例接受一线纳武单抗化疗的d-MMR晚期GC患者。作为对照组,68例患者仅接受一线化疗。临床病理因素,包括中性粒细胞与淋巴细胞比率（NLR）和PD-L1联合阳性评分（CPS），对疗效结果进行了分析。
结果：无进展生存期（PFS）更长（中位PFS；未达到[NR]vs.5.2个月,危险比[HR]0.28，P<0.001)，总生存期（OS）趋于更长（中位OS；NR与17.9个月，HR0.43，P=0.057）在接受纳武单抗化疗治疗的患者中高于接受化疗的患者。在NLR较低（<3.80[NLR中位数]）的亚组中，nivolumab化疗的PFS获益明显优于化疗（HR0.10），而在NLR高(≥3.80)(HR0.58)的患者中则不太明显.在接受纳武单抗化疗的患者中，NLR较高（≥3.80）的患者的PFS比NLR较低（<3.80）的患者更差。PD-L1CPS≥5和<5的患者的生存结局相似。
结论：在d-MMRGC患者中，Nivolumab化疗比单独化疗具有更好的疗效。但对于NLR较高的患者,即使使用nivolumab化疗,生存结局也较差.根据PD-L1CPS，接受纳武单抗化疗的d-MMR患者的生存结果没有差异。
方法：这项回顾性研究包括28例接受一线纳武单抗化疗的d-MMR晚期GC患者。作为对照组,68例患者仅接受一线化疗。临床病理因素,包括中性粒细胞与淋巴细胞比率（NLR）和PD-L1联合阳性评分（CPS），对疗效结果进行了分析。
结果：无进展生存期（PFS）更长（中位PFS；未达到[NR]vs.5.2个月,危险比[HR]0.28，P<0.001)，总生存期（OS）趋于更长（中位OS；NR与17.9个月，HR0.43，P=0.057）在接受纳武单抗化疗治疗的患者中高于接受化疗的患者。在NLR较低（<3.80[NLR中位数]）的亚组中，nivolumab化疗的PFS获益明显优于化疗（HR0.10），而在NLR高(≥3.80)(HR0.58)的患者中则不太明显.在接受纳武单抗化疗的患者中，NLR较高（≥3.80）的患者的PFS比NLR较低（<3.80）的患者更差。PD-L1CPS≥5和<5的患者的生存结局相似。
结论：在d-MMRGC患者中，Nivolumab化疗比单独化疗具有更好的疗效。但对于NLR较高的患者,即使使用nivolumab化疗,生存结局也较差.根据PD-L1CPS，接受纳武单抗化疗的d-MMR患者的生存结果没有差异。
