# Association between splenic volume changes and prognosis in advanced gastric cancer patients receiving chemotherapy combined with immunotherapy

## TL;DR

This study found that changes in spleen size on CT scans can predict survival outcomes in advanced stomach cancer patients undergoing chemotherapy and immunotherapy.

## Contribution

The study identifies splenic volume changes as a novel prognostic biomarker in advanced gastric cancer patients treated with chemotherapy and immunotherapy.

## Key findings

- Increased splenic volume was associated with significantly shorter progression-free and overall survival in cancer patients.
- A nomogram incorporating splenic volume changes showed better predictive performance than stage-based models for patient survival.

## Abstract

The prognostic value of splenic volume (SV) in patients with advanced gastric cancer receiving chemotherapy combined with immunotherapy remains unclear. This study aimed to evaluate the association between CT-assessed changes in SV and clinical outcomes, exploring its potential as a prognostic biomarker.

This retrospective cohort study included 138 advanced gastric cancer patients receiving chemotherapy combined with immunotherapy. Patients were stratified into an increased group (ΔSV > 14%, n = 87) and a non-increased group (ΔSV ≤ 14%, n = 51) based on the optimal cutoff value of 14% for the annualized change in splenic volume (ΔSV). Kaplan-Meier survival analysis, Cox proportional hazards models, and restricted cubic spline analyses were used to assess prognostic associations. A nomogram incorporating ΔSV was constructed for survival prediction.

The increased group showed significantly shorter median progression-free survival (PFS) (14.8 vs. 26.6 months, P < 0.001) and overall survival (OS) (18.9 vs. 30.9 months, P < 0.001) compared to the non-increased group. Multivariate analysis identified ΔSV >14% as an independent risk factor for both PFS (HR, 0.424 [95% CI, 0.238 - 0.755]; P< 0.001) and OS (HR, 0.233 [95% CI, 0.109 - 0.501]; P < 0.001). A nomogram integrating ΔSV, stages, and other indicators demonstrated significantly better predictive performance than a stages-only model (1-year OS AUC: 0.802 vs. 0.564; 2-year OS AUC: 0.883 vs. 0.686).

Increased SV is associated with poorer clinical outcomes in advanced gastric cancer patients receiving chemotherapy combined with immunotherapy.