European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Integrating multi-omics data for enhanced prognosis prediction in gastric cancer post-neoadjuvant therapy.
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Huang Ze-Ning, Zhang Hao-Xiang, Chen Feng, Liu Zhi-Wei, Wang Lei, Li Yi, Weng Cai-Ming, He Ji-Xun, Zhuang Hong-Yuan, Zheng Chao-Hui, Li Ping, Wang Jia-Bin, Chen Qi-Yue, Cao Long-Long, Lin Mi, Tu Ru-Hong, Wang Bin, Huang Chang-Ming, Lin Jian-Xian, Xie Jian-Wei
Аннотация
BACKGROUND: Neoadjuvant therapy is crucial for locally advanced gastric cancer (LAGC), yet response varies significantly. Traditional models based on clinicopathological features often lack precision. This study aimed to develop and validate a comprehensive prognostic model integrating deep learning features from CT images and immune scores to improve risk assessment.
METHODS: A total of 179 LAGC patients who received neoadjuvant therapy between 2019 and 2022 were divided into a development cohort (DC, n = 125) and an internal validation cohort (IVC, n = 54). Additionally, an external validation cohort (EVC) of 29 patients was included. Pre-treatment abdominal enhanced CT images were analyzed using a ResNet18-based deep learning model to extract features and generate a DeepScore via univariate Cox and LASSO regression. ImmuneScore was calculated from postoperative transcriptome data using the ESTIMATE algorithm. A multi-omics nomogram combining DeepScore, ImmuneScore, and ypTNM stage was constructed, calibrated in the development cohort, and validated.
RESULTS: In the DC, 3-year DFS rates for high, medium, and low DeepScore groups were 83.3%, 71.4%, and 29.3% (P < 0.0001); in the IVC, they were 92.0%, 66.7%, and 35.7% (P = 0.0011). The integrated nomogram achieved AUCs of 0.858, 0.843, and 0.839 (1-, 2-, 3-year DFS) in the DC, and 0.844, 0.825, and 0.833 in the IVC. In the EVC, the nomogram achieved AUCs of 0.786 and 0.785 for 1- and 2-year DFS, respectively. Low-risk patients showed significantly higher 3-year DFS and OS than high-risk patients in both DC and IVC cohorts (all P < 0.001). ssGSEA revealed higher immune infiltration in the low-risk group, and GSEA indicated enrichment in immune-related pathways.
CONCLUSION: The integrated model combining deep learning and immune scores enhances prognostic accuracy for LAGC patients after neoadjuvant therapy, offering valuable support for clinical decision-making.
METHODS: A total of 179 LAGC patients who received neoadjuvant therapy between 2019 and 2022 were divided into a development cohort (DC, n = 125) and an internal validation cohort (IVC, n = 54). Additionally, an external validation cohort (EVC) of 29 patients was included. Pre-treatment abdominal enhanced CT images were analyzed using a ResNet18-based deep learning model to extract features and generate a DeepScore via univariate Cox and LASSO regression. ImmuneScore was calculated from postoperative transcriptome data using the ESTIMATE algorithm. A multi-omics nomogram combining DeepScore, ImmuneScore, and ypTNM stage was constructed, calibrated in the development cohort, and validated.
RESULTS: In the DC, 3-year DFS rates for high, medium, and low DeepScore groups were 83.3%, 71.4%, and 29.3% (P < 0.0001); in the IVC, they were 92.0%, 66.7%, and 35.7% (P = 0.0011). The integrated nomogram achieved AUCs of 0.858, 0.843, and 0.839 (1-, 2-, 3-year DFS) in the DC, and 0.844, 0.825, and 0.833 in the IVC. In the EVC, the nomogram achieved AUCs of 0.786 and 0.785 for 1- and 2-year DFS, respectively. Low-risk patients showed significantly higher 3-year DFS and OS than high-risk patients in both DC and IVC cohorts (all P < 0.001). ssGSEA revealed higher immune infiltration in the low-risk group, and GSEA indicated enrichment in immune-related pathways.
CONCLUSION: The integrated model combining deep learning and immune scores enhances prognostic accuracy for LAGC patients after neoadjuvant therapy, offering valuable support for clinical decision-making.