Background Due to the correlation between nutritional status, systemic inflammation and tumor progression, albumin and neutrophil combined prognostic grade (ANPG) may predict the prognosis of patients with advanced gastric cancer (AGC) treated with immune checkpoint inhibitors (ICIs).
Objective To explore the relationship between the median overall survival (OS) and median progression-free survival (PFS) of patients with AGC and ANPG before immunotherapy.
Methods Totally 123 AGC patients (staged Ⅲ-Ⅳ) receiving immunotherapy in the First Medical Center, Chinese PLA General Hospital from December 2014 to November 2018 were enrolled. Low level of serum albumin (＜35 g/L) and high level of neutrophil (≥4.26 g/L) were considered to be two risk factors for ANPG. According to these two risk factors, the patients were divided into high ANPG score group (no risk factors), and intermediate/low ANPG score group (with one risk factor or two risk factors). At last, the differences of OS and PFS between the two groups were evaluated.
Results The median age of the 123 enrolled AGC patients was 58 years old, with 31 females and 92 males. The OS (5.4 months vs 12.7 months, P＜0.001) and PFS (3.3 months vs 4.6 months, P=0.009) of the patients in the intermediate/low ANPG score group were shorter than those in the high ANPG score group. Cox multivariate analysis showed that the risk of death in the intermediate/low ANPG score group was 2.3 times higher than that of the high ANPG score group (HR, 2.302; 95% CI, 1.507-3.515, P＜0.001) and the risk of disease progression in the intermediate/low ANPG score group was 1.8 times higher than that of the high ANPG score group (HR, 1.885; 95% CI, 1.284-2.767, P=0.001).
Conclusion Our study confirms that ANPG is an independent factor affecting the survival of AGC patients receiving immunotherapy. Patients in the high ANPG score group have prolonged overall survival after immunotherapy.
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