Gaku, Ohira

Masayuki, Kano

Hiroshi, Suito

Yasunori, Matsumoto

Yoshihiro, Kurata

Ryota, Otsuka

Tetsuro, Isozaki

Takeshi, Toyozumi

Kentaro, Murakami

Masaya, Uesato

Hisahiro, Matsubara

Prognosis

Stomach Neoplasms

Insulin-Like Growth Factor I

Sarcopenia

Neoplasm Recurrence, Local

Lymphocytes

Neutrophils

Inflammation

Fatty Liver

Immunotherapy

Hormones

Retrospective Studies

Hepatic steatosis

Gastric cancer

Cancer cachexia

Immune checkpoint inhibitor

Unresectable or recurrent GC treated with ICIs was investigated. Using unenhanced CT, the liver-to-spleen CT attenuation ratio (LSR) was calculated as a parameter of hepatic steatosis. LSR was compared with the presence of sarcopenia and inflammatory markers including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR). These parameters were also compared with disease-specific survival (DSS) and progression-free survival (PFS). Associations of LSR with insulin-like growth factor 1 (IGF-1) and growth hormone were also evaluated.

A total of 70 patients were investigated. LSR of sarcopenia patients was significantly lower than that of non-sarcopenic ones (p = 0.02). LSR showed significant negative correlations with NLR, PLR, and MLR (p = 0.003, 0.03, 0.01, respectively). Lower LSR was significantly associated with a higher level of serum IGF-1 (p = 0.03). In univariate analysis, LSR was significantly correlated with DSS and PFS (both p < 0.0001), and multivariate analysis demonstrated that LSR was the independent prognostic factor for both DSS and PFS (both p = 0.01). ROC analysis demonstrated that LSR >1.263 was a good predictive marker for favorable DSS (>5.3 months) with an AUC of 0.80.

Hepatic steatosis can be a promising prognostic biomarker for ICI therapy of GC, associated with sarcopenia and the elevation of inflammatory markers. Our data suggested that GC with steatohepatitis might be less responsive to ICI therapy.