BACKGROUND The development and progression of gastric cancer (GC) are closely linked to the nutritional status of patients. Although immunotherapy has been demonstrated to be clinically effective, the relationships of sarcopenia and myosteatosis with the use of immune checkpoint inhibitors (ICIs) in patients with gastric cancer remain to be characterized. AIM To assess the effects of sarcopenia and myosteatosis on the clinical outcomes of patients with GC undergoing treatment with an ICI. METHODS We performed a retrospective study of patients who were undergoing immunotherapy for GC. For the evaluation of sarcopenia, the optimal cut-off value for the skeletal muscle index was established using receiver operating characteristic analysis of data obtained from pre-treatment computed tomography images at the L3 vertebral level. Myosteatosis was defined using the mean skeletal muscle density (SMD), with a threshold value of < 41 Hounsfield units (HU) for patients with a body mass index (BMI) < 25 kg/m² and < 33 HU for those with a BMI ≥ 25 kg/m². The log-rank test was used to compare progression-free survival (PFS) and overall survival (OS), and a Cox proportional hazard model was used to identify prognostic factors. Nomograms were developed to predict the PFS and OS of patients on the basis of the results of multivariate analyses. RESULTS We studied 115 patients who were undergoing ICI therapy for GC, of whom 27.4% had sarcopenia and 29.8% had myosteatosis. Patients with sarcopenia or myosteatosis had significantly shorter PFS and OS than those without these conditions. Furthermore, both sarcopenia and myosteatosis were found to be independent predictors of PFS and OS in patients with GC administering an ICI. The prediction models created for PFS and OS were associated with C-indexes of 0.758 and 0.781, respectively. CONCLUSION The presence of sarcopenia or myosteatosis is a reliable predictor of the clinical outcomes of patients with GC who are undergoing treatment with an ICI.

Objective: This study aimed to investigate the prognostic significance of the Prognostic Nutritional Index (PNI) in conjunction with body composition change indices, namely subcutaneous fat area (SFA) and skeletal muscle index (SMI), with regard to clinical outcomes in patients with gastric cancer (GC) undergoing immune checkpoint inhibitors (ICIs) treatment.Methods: This retrospective investigation encompassed patients with comprehensive clinical and pathological data, inclusive of portal phase enhanced CT images. Continuous variables underwent analysis utilizing the Student t‐test or Mann–Whitney U‐test, while categorical variables were assessed employing the Pearson chi‐squared test or Fisher test. Survival outcomes were evaluated using Kaplan–Meier survival curves and the Log‐rank test. Independent prognostic indicators were determined through Cox regression analysis, and a nomogram predicting survival probability for progression‐free survival (PFS) and overall survival (OS) was constructed.Results: Within the PNI‐SFA groups, patients in Group 1 exhibited inferior PFS and OS compared to the other two groups. Similarly, among the PNI‐SMI groups, Group 1 patients demonstrated poorer PFS and OS. PNI‐SMI and Eosi were identified as independent prognostic factors through Cox regression analysis. Furthermore, positive associations with patient prognosis were observed for BMI, SAF, SMI, and PNI.Conclusion: The comprehensive consideration of PNI‐SFA and PNI‐SMI proved to be a superior prognostic predictor for GC patients undergoing ICI treatment.

BACKGROUND Studies have demonstrated the influence of immunity and inflammation on the development of tumors. Although single biomarkers of immunity and inflammation have been shown to be clinically predictive, the use of biomarkers integrating both to predict prognosis in patients with gastric cancer remains to be investigated. AIM To investigate the prognostic and clinical significance of inflammatory biomarkers and lymphocytes in patients undergoing surgical treatment for gastric cancer. METHODS Univariate COX regression analysis was performed to identify potential prognostic factors for patients with gastric cancer undergoing surgical treatment. Least absolute shrinkage and selection operator-COX (LASSO-COX) regression analysis was performed to integrate these factors and formulate a new prognostic immunoinflammatory index (PII). The correlation between PII and clinical characteristics was statistically analyzed. Nomograms incorporating the PII score were devised and validated based on the time-dependent area under the curve and decision curve analysis. RESULTS Patients exhibiting elevated neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune inflammatory index displayed inferior progression-free survival (PFS) and overall survival (OS). Conversely, low levels of CD3(+), CD3(+) CD8(+), CD4(+)CD8(+), and CD3(+)CD16(+)CD56(+) T lymphocytes were associated with improved PFS and OS, while high CD19(+) T lymphocyte levels were linked to worse PFS and OS. The PII score demonstrated associations with tumor characteristics (primary tumor site and tumor size), establishing itself as an independent prognostic factor for both PFS and OS. Time-dependent area under the curve and decision curve analysis affirmed the effectiveness of the PII-based nomogram as a robust prognostic predictive model. CONCLUSION PII may be a reliable predictor of prognosis in patients with gastric cancer undergoing surgical treatment, and it offers insights into cancer-related immune-inflammatory responses, with potential significance in clinical practice.

Background Immunotherapy has recently emerged as a popular treatment option. This study looked into the predictive significance of the nutritional inflammation binding indicator, neutrophil-to-lymphocyte ratio-skeletal muscle mass index (NLR-SMI), in patients with gastric cancer receiving immune checkpoint inhibitor (ICIs) treatment. Methods This study included 199 patients with complete clinical data from September 2016 to October 2022, of whom 124 (62.3%) were treated with ICIs. Mortality rates in the first and fifth years of this sample were 8.5% and 38.7%, respectively. males and females accounted for 73.3% and 26.7% respectively. Clinical data differences were analyzed by using chi-square, Fisher's exact test, or Student's T-test. Patients’ survival differences were analyzed by Kaplan-Meier and log-rank tests. We created nomograms to predict survival probabilities based on separate prognostic indicators, and we utilized Cox's regression analysis to develop independent prognostic factors for patients. Results By univariate and multivariate analyses, NLR-SMI was found to be an independent prognostic factor for progression-free survival (PFS) and Overall survival (OS) (P < 0.05), and the higher NLR-SMI score is, the better the prognosis with for patients. Compared with chemotherapy, NLR-SMI had good prognostic value in the immunotherapy subgroup. According to a time-dependent ROC analysis, the AUC area for NLR-SMI hit the record in the third year. Conclusion The combination of NLR and SMI as a new nutritional indicator of inflammation can predict the prognosis of gastric cancer patients treated with ICIs.

Objective:The primary objective of this retrospective study was to assess the influence of sarcopenia and myosteatosis on clinical outcomes in patients with gastric cancer (GC) who underwent treatment with Immune Checkpoint Inhibitors (ICIs). Methods:In this retrospective analysis, the study cohort comprised patients who had received immunotherapy for gastric cancer. Sarcopenia, evaluated at the L3 vertebral level, was determined based on pre-treatment CT scans using the Receiver Operating Characteristic (ROC) analysis to establish the optimal skeletal muscle index cut-off value. Myosteatosis was defined using the mean Skeletal Muscle Density (SMD), with a threshold value of <41 Hounsfield Units (HU) for patients with a Body Mass Index (BMI) < 25 kg/m² and <33 HU for patients with a BMI ≥ 25 kg/m². Statistical analyses, including the log-rank test and the Cox proportional hazard model, were employed to compare both Progression-Free Survival (PFS) and Overall Survival (OS). Nomograms predicting PFS and OS were developed based on the results of multivariate analyses. Results: The study encompassed a total of 124 patients who had undergone ICIs for GC, among which 27.4% exhibited sarcopenia, and 29.8% displayed myosteatosis. Patients with sarcopenia or myosteatosis exhibited significantly reduced PFS and OS compared to those without these conditions. Furthermore, both sarcopenia and myosteatosis emerged as independent prognostic factors for PFS and OS in GC patients receiving ICIs. The prediction models for PFS and OS demonstrated C-indexes of 0.757 and 0.777, respectively. Conclusion: The findings of this study affirm the utility of sarcopenia and myosteatosis as reliable biomarkers for forecasting clinical outcomes in patients with gastric cancer who are undergoing treatment with ICIs.