Abstract
BACKGROUND: Several nutritional and inflammatory indices can predict the efficacy of immune checkpoint inhibitors and the prognosis in various cancers. However, indices that are useful for patients with advanced gastric cancer (AGC) remain unclear. MATERIALS AND METHODS: This retrospective study was conducted at a single cancer center. Patients with AGC who received nivolumab as a third- or later-line treatment between June 2017 and May 2023 were selected. The association between nutritional and inflammatory indices and clinical outcomes was analyzed. RESULTS: In total, 277 patients were analyzed. Multivariate analysis revealed that several indices were significantly associated with time to treatment failure (TTF) and overall survival (OS) after adjustment for clinicopathological factors. The modified Glasgow prognostic score (mGPS) and systemic immune-inflammation index (SII) were identified as the most promising indices. A combined score (CS) developed by summing the SII and mGPS was associated with a shorter TTF and OS in CS 1 or 2 than in CS 0 [TTF: hazard ratio (HR) 1.39, 95% confidence interval (CI) 1.04-1.87, P = 0.03 for CS 1 and HR 2.04, 95% CI 1.49-2.80, P < 0.01 for CS 2; OS: HR 1.45, 95% CI 1.08-1.96, P < 0.01 for CS 1 and HR 2.81, 95% CI 2.06-3.82, P < 0.01 for CS 2]. CS 2 had a positive predictive value of 78.1% for detecting the first progressive disease. The clinical significance of CS was also confirmed in the first-line cohort. CONCLUSION: CS may be useful for predicting treatment efficacy and prognosis in nivolumab-treated patients with AGC.