ArticleGastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association2025
Paradoxical effects of adiposity and inflammation on immunotherapy efficacy in gastric cancer: novel insights from real-world data.
Article in Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Prognostic value of the systemic immune-inflammation index in gastrointestinal cancers treated with immune checkpoint inhibitors: a systematic review and meta-analysis.BMC gastroenterology · 2026Pooled it
- Establishment of a Gastric Cancer Diagnostic Model Based on the Combined Evaluation of Peripheral Blood Immune-inflammatory Nutritional Indicators and Tumor Markers.Journal of cancer prevention · 2026Article
- Development and validation of nomograms integrating electrolyte, nutritional, and inflammatory indicators to predict survival in advanced esophageal cancer undergoing immunotherapy or radioimmunotherapy.Journal of thoracic disease · 2026Article
- Explainable machine learning-driven models for predicting Parkinson's disease and its prognosis: obesity patterns associations and models development using NHANES 1999-2018 data.Lipids in health and disease · 2025Article
- Prognostic Enhancement in Gastric Cancer Through the Integration of Inflammatory Indices into the pTNM-Inflammation Staging System (pTNM-I).Journal of inflammation research · 2025Article
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Funding
Abstract
backgroundEmerging studies suggest obesity may improve PD-1/PD-L1 inhibitor efficacy, correlating with prolonged survival, known as the 'obesity paradox'. However, the impact of this paradox and obesity-related chronic inflammation on immunotherapy for advanced gastric cancer (AGC) has not received sufficient research.
methodsBetween January 2018 and December 2021, patients receiving neoadjuvant therapy were categorized into two groups: combined immunotherapy (ICIs, n = 173) and neoadjuvant chemotherapy (NAC, n = 126). Visceral (VATI) and subcutaneous adipose tissue index (SATI) were obtained from pre-treatment CT images. The systemic immune-inflammation index (SII) was calculated as platelet count multiplied by the neutrophil-to-lymphocyte ratio.
resultsThe median age of patients was 64 years (IQR 56-69), with 219 (73.2%) males and 80 (26.8%) females. In the ICIs group, the VATI-High group showed significantly higher 3-year overall survival (OS) (p = 0.010) and disease-free survival (DFS) (p = 0.029). Similar results were observed in the SATI analysis (p < 0.05). Conversely, OS (p = 0.040) and DFS (p = 0.039) were significantly lower in the SII-High group. Both VATI and SATI were independent protective factors for OS and DFS, but the effect disappeared after adjustment for SII. SII was associated with poorer OS and DFS, even after adjustment for VATI and SATI. No significant differences were observed in the analysis of the NAC group.
conclusionsElevated adiposity indices (VATI/SATI) and low SII correlate with survival benefit in ICI-treated AGC patients, and importantly, this paradoxical survival benefit is dependent on SII status. In contrast, no such benefit is observed in chemotherapy-alone cohorts.
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