Hematological biomarkers for predicting pathologic response to neoadjuvant immunochemotherapy and cycle optimization in locally advanced gastric cancer

BackgroundThe predictive value of hematological parameters for pathologic response to neoadjuvant immunochemotherapy (NICT) in locally advanced gastric cancer (LAGC) remains unclear.MethodsThis retrospective study consecutively enrolled 246 LAGC patients who received NICT followed by radical gastrectomy at The First Hospital of Lanzhou University (2021-2024). Based on postoperative pathology, patients were classified into major pathologic response (MPR, tumor regression grade [TRG] 1a/1b, residual tumor ≤10%) and incomplete pathologic response (IPR, TRG 2/3, residual tumor >10%) groups.

Hematological parameters pre- and post-treatment were analyzed. Logistic regression and receiver operating characteristic (ROC) analyses were employed (statistical significance: p<0.05).ResultsMultivariate analysis identified pre-treatment neutrophil count (Neutrophil_pre) (adjusted odds ratio [OR]: 0.83, 95% CI: 0.70–0.99, P = 0.033) and post-treatment albumin (ALB_post) (adjusted OR: 0.92, 95% CI: 0.85–1.00, P = 0.042) as independent protective factors for MPR, while post-treatment platelet count (PLT_post) was an independent risk factor (adjusted OR: 1.01, 95% CI: 1.00–1.01, P = 0.014).

These associations were absent in a chemotherapy-alone control cohort (n=147). ROC analysis determined the optimal pre-treatment neutrophil cutoff at 3.39×109/L.