Evidence map›Paper›PMID 39696266›Full record

Observational studyBMC medicine2024

Efficacy, safety, and biomarker analysis of first-line immune checkpoint inhibitors with chemotherapy versus chemotherapy for advanced gastric cancer: a multicenter, retrospective cohort study.

Xue Zhang, Xin Dai, Aina Liu, Meili Sun, Lei Cong, Jing Liang, Zimin Liu, Zhen Li, Jinling Zhang, Jing Lv and 19 more

Erratum issuedAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMC medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 12 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Use of PD-1/PD-L1 inhibitors in non-small cell lung cancer in elderly patients: a meta-analysis and systematic review of randomized clinical trials.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2026
    Pooled it
  3. Pooled it
  4. Prognostic implications of tissue-based homologous recombination deficiency in metastatic gastric cancer treated with immune checkpoint inhibitor plus chemotherapy.Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association · 2026
    Article
  5. Article
  6. Review
  7. Review
  8. Observational
  9. Article
  10. Article
  11. Review
  12. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

29 authors.

Xue Zhang *Department of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
Xin Dai *Department of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
Aina Liu *Department of Oncology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
Meili SunDepartment of Oncology, Central Hospital Affiliated to Shandong First Medical University , Jinan, China.
Lei CongDepartment of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University , Jinan, China.
Jing LiangDepartment of Oncology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.
Zimin LiuDepartment of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Zhen LiDepartment of Oncology, Linyi Cancer Hospital, Linyi, China.
Jinling ZhangDepartment of Oncology, Linyi People's Hospital, Linyi, China.
Jing LvDepartment of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Fangli CaoDepartment of Medical Oncology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China.
Linli QuDepartment of Medical Oncology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China.
Haiyan LiuDepartment of Oncology, The Second Affiliated Hospital of Shandong First Medical University, Jinan, China.
Lu YueDepartment of Oncology, Qingdao Municipal Hospital, Qingdao, China.
Yi ZhaiDepartment of Oncology, Zibo Center Hospital, Zibo, China.
Fujun YangDepartment of Oncology, Weihai Municipal Hospital, Weihai, China.
Jiahui ChuDepartment of Pharmacy, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Shuang WangDepartment of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
Qian XuDepartment of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
Jianyuan ZhouDepartment of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
Shulun NieDepartment of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
Miao HuangDepartment of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
Ruitao XuDepartment of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
Qiushi WangDepartment of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
Xinyu SongDepartment of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
Di ZhangDepartment of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
Zhaodi NanDepartment of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
Song LiDepartment of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China. songli@sdu.edu.cn.
Lian LiuDepartment of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China. lianliu@sdu.edu.cn.

Funding

National Natural Science Foundation of China 82173305
6 · The paper itself

Abstract

backgroundRecent phase III randomized controlled trials have demonstrated that first-line immune checkpoint inhibitors (ICIs) improve prognosis in advanced HER-2-negative gastric cancer patients with programmed death ligand 1 (PD-L1) combined positive score (CPS) higher than 5. However, these findings are not confirmed in real-world settings, and the benefits in PD-L1 CPS < 5 patients remain controversial.

methodsIn this multicenter, retrospective cohort study, data from across thirteen medical centers were analyzed by inverse probability of treatment weighting for matching, alongside univariate and multivariate COX proportional hazard regression models. Genomic and transcriptomic analyses were conducted to identify efficacy prognostic models and resistance mechanisms.

resultsThis study included 573 patients with advanced gastric cancer, 265 treated with chemotherapy and 308 with ICIs plus chemotherapy. In the overall cohort and HER-2-negative patients, the combination therapy significantly improved progression-free survival and overall survival, without marked increases in severe adverse events. Notably, patients with PD-L1 CPS 1-4 showed significant overall survival prolongation and a trend towards improved progression-free survival with combination therapy. Patients with unknown PD-L1 status also benefitted from ICIs. SMARCA4 and BRCA2 mutations were more frequent in patients with responses, while CCNE1 and ZFHX3 alternation, alongside high "ABC transporters" signatures, were more common in non-responsive patients. A novel risk model, PGFIC, outperformed traditional biomarkers in predicting treatment outcomes.

conclusionsAdding ICIs to first-line treatment significantly prolongs survival in overall patients and in those with PD-L1 CPS 1-4 or unknown. This study also provides valuable insights into prognostic markers and resistance mechanisms, potentially guiding immunotherapy strategies.

Indexed as

Biomarkers, TumorImmune Checkpoint InhibitorsStomach NeoplasmsAdultAgedAged, 80 and overAntineoplastic Combined Chemotherapy ProtocolsB7-H1 AntigenBRCA2 ProteinFemaleHumansMaleMiddle AgedPrognosisRetrospective StudiesTreatment OutcomeB7-H1 AntigenBiomarkers, TumorBRCA2 ProteinCD274 protein, humanImmune Checkpoint InhibitorsFirst-line treatmentGastric cancerImmune checkpoint inhibitorMulti-omicsRetrospective study

Identifiers

PMID39696266
PMCPMC11657984

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.