Peripheral blood marker changes predict response and prognosis in locally advanced gastric cancer with neoadjuvant sintilimab plus XELOX

doi:10.4251/wjgo.122796

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. Oct 15, 2026; 18(10): 122796
Published online Oct 15, 2026. doi: 10.4251/wjgo.122796

Peripheral blood marker changes predict response and prognosis in locally advanced gastric cancer with neoadjuvant sintilimab plus XELOX

Yan Wu, Mi-Mi Xu, Guo-Lin Wang, Wen-Di Du, Xin-Hui Su

Yan Wu, Mi-Mi Xu, Guo-Lin Wang, Wen-Di Du, Xin-Hui Su, Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China

Author contributions: Wu Y formulated the conceptual framework and undertook the primary drafting of this paper; Xu MM developed the analytical methods and study design for this research; Wang GL performed the data collection and collation for this study; Du WD constructed the tables and figures for the article; Su XH was responsible for revising and editing the manuscript. All authors approved the final version to publish.

AI contribution statement: AI tools only serve to correct grammar.

Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine, No. 20230569.

Informed consent statement: Individual informed consent was waived for this retrospective analysis.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The dataset is available upon request from the corresponding author.

Corresponding author: Xin-Hui Su, MD, PhD, Academic Fellow, Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. suxinhui@zju.edu.cn

Received: April 29, 2026
Revised: June 11, 2026
Accepted: June 30, 2026
Published online: October 15, 2026
Processing time: 142 Days and 17.5 Hours

Abstract

BACKGROUND

Neoadjuvant immunotherapy with chemotherapy (NICT) is a relatively advanced treatment modality for locally advanced gastric cancer (LAGC). However, reliable peripheral blood biomarkers for predicting the efficacy and prognosis of this therapy remain lacking. We aimed to investigate and evaluate whether baseline and post-treatment changes in peripheral blood inflammatory markers and T lymphocyte subsets could serve as potential predictive and prognostic indicators for patients with LAGC receiving NICT.

AIM

To investigate the association between changes in peripheral blood markers, treatment response, and prognosis in patients with LAGC.

METHODS

We conducted a retrospective analysis of clinical data from 39 patients with LAGC who received neoadjuvant therapy with sintilimab and XELOX chemotherapy. Peripheral blood samples were collected at baseline and after treatment completion for complete blood count and T-cell subset analyses. The patients were divided into the major pathological response group (tumor regression grade = 0-1) and non-major pathological response group (tumor regression grade = 2-3). The independent predictors of therapeutic efficacy and factors related to progression-free survival were explored.

RESULTS

Multivariate analysis revealed that low-adhesion gastric cancer (non-poorly vs poorly cohesive gastric adenocarcinoma) (odds ratio = 8.522, P = 0.036) and a higher post-treatment monocyte-to-lymphocyte ratio (MLR) (odds ratio = 2.479, P = 0.035) were associated with a favorable response to treatment. A higher relative change rate in CD8+ T lymphocytes (hazard ratio = 0.970, P = 0.024) and diffuse gastric cancer (hazard ratio = 5.545, P = 0.011) may be potential prognostic factors for progression-free survival. The lymphocyte count (significant decrease from 1.44 × 10⁹/L to 1.18 × 10⁹/L, P < 0.001) and the platelet-to-lymphocyte ratio showed significant decreases. By contrast, the monocyte count, CD3+ and CD8+ T-cell counts, and MLR all showed significant increases (all P < 0.005).

CONCLUSION

Post-treatment MLR and relative change in CD8+ T-cell proportion are potential prognostic biomarkers for patients with LAGC receiving NICT, whereas diffuse-type gastric cancer may be related to poor prognosis.

Keywords: Gastric cancer; Peripheral blood; Neoadjuvant therapy; Immunotherapy; Sintilimab; Gastric signet ring cell carcinoma; Gastric carcinoma subtypes

Core Tip: This study investigated the changes in peripheral blood inflammatory markers and T-cell subsets in patients with gastric cancer at baseline and after neoadjuvant chemotherapy with sintilimab combined with XELOX. Results indicate that high post-treatment monocyte-to-lymphocyte ratio levels are associated with a favorable treatment response, a greater relative change in the proportion of CD8+ T cells may be associated with better prognosis, and diffuse-type gastric cancer may be associated with poorer clinical outcomes. These easily detectable biomarkers offer a new perspective for predicting treatment response and assessing prognosis; however, further validation is required.