International immunopharmacology · 2026
Dynamic monitoring of circulating tumor cells and PD-L1 combined positive score as prognostic biomarkers for adjuvant immunochemotherapy in stage III gastric cancer: A prospective observational study.
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Guo Xiaoyu, Qu Ziting, Wang Yuyan, Huang Luyao, Cheng Mengting, Huang Nana, Wei Xiaoli, Gu Kangsheng, Zhang Yiyin
Аннотация
BACKGROUND: Patients with stage III gastric cancer (GC) face a high risk of recurrence after radical resection, and the significance of circulating tumor cells (CTCs) and Programmed death-ligand 1 (PD-L1) combined positive score (CPS) in adjuvant therapy remains unclear.
METHODS: In this prospective observational cohort study, we analyzed 76 stage III GC patients post-D2 resection who received either chemotherapy alone (n = 46) or immunochemotherapy (n = 30) based on clinical decision-making. CTCs levels at baseline and after 6 treatment cycles were assessed using a folate receptor-based qPCR assay, while PD-L1 CPS was evaluated via immunohistochemistry. We also analyzed the time difference between CTCs elevation and radiological relapse.
RESULTS: Although a single baseline CTCs lacked independent prognostic value, dynamic increases in CTCs during treatment served as an independent predictor of disease-free survival (DFS) and overall survival (OS) in GC patients (P = 0.019, P = 0.013). Notably, elevated CTCs significantly preceded radiographic recurrence confirmation by a median of 284.5 days (P < 0.001). In the immunochemotherapy cohort, PD-L1 CPS ≥ 5, but not CPS ≥ 1, might help identify patients with greater DFS and OS benefits (P = 0.038, P = 0.023).
CONCLUSION: Dynamic monitoring of CTCs serves as a sensitive early-warning tool for recurrence and an independent prognostic indicator for DFS in stage III GC. Furthermore, a PD-L1 CPS threshold of ≥5 may help stratify candidates for adjuvant immunotherapy, though OS findings are exploratory pending validation in larger cohorts. This study confirms the clinical value of dynamic CTCs monitoring in prognostic assessment and early recurrence warning, as well as the potential significance of PD-L1 CPS in guiding patient selection for adjuvant immunotherapy in stage III GC.
METHODS: In this prospective observational cohort study, we analyzed 76 stage III GC patients post-D2 resection who received either chemotherapy alone (n = 46) or immunochemotherapy (n = 30) based on clinical decision-making. CTCs levels at baseline and after 6 treatment cycles were assessed using a folate receptor-based qPCR assay, while PD-L1 CPS was evaluated via immunohistochemistry. We also analyzed the time difference between CTCs elevation and radiological relapse.
RESULTS: Although a single baseline CTCs lacked independent prognostic value, dynamic increases in CTCs during treatment served as an independent predictor of disease-free survival (DFS) and overall survival (OS) in GC patients (P = 0.019, P = 0.013). Notably, elevated CTCs significantly preceded radiographic recurrence confirmation by a median of 284.5 days (P < 0.001). In the immunochemotherapy cohort, PD-L1 CPS ≥ 5, but not CPS ≥ 1, might help identify patients with greater DFS and OS benefits (P = 0.038, P = 0.023).
CONCLUSION: Dynamic monitoring of CTCs serves as a sensitive early-warning tool for recurrence and an independent prognostic indicator for DFS in stage III GC. Furthermore, a PD-L1 CPS threshold of ≥5 may help stratify candidates for adjuvant immunotherapy, though OS findings are exploratory pending validation in larger cohorts. This study confirms the clinical value of dynamic CTCs monitoring in prognostic assessment and early recurrence warning, as well as the potential significance of PD-L1 CPS in guiding patient selection for adjuvant immunotherapy in stage III GC.