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Hematological biomarkers for predicting pathologic response to neoadjuvant immunochemotherapy and cycle optimization
Xinglong Lu1, Xiang Cui2, Hao Chen1
1The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.
Background:
The predictive value of hematological parameters for pathologic response to neoadjuvant immunochemotherapy (NICT) in locally advanced gastric cancer (LAGC) remains unclear.
Methods:
This 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).
Results:
Multivariate 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. Subgroup analysis showed that among patients with pre-treatment neutrophils <3.39×109/L, those receiving 4 (vs. 2-3) cycles of neoadjuvant therapy had significantly higher MPR (35.7% vs. 16.9%, P = 0.039) and pathologic complete response (pCR) rates (32.1% vs. 9.1%, P = 0.011).
Conclusion:
Pre-treatment neutrophil count, post-treatment platelet count, and post-treatment albumin level are independent predictors of pathologic response to NICT in LAGC. Patients with low pre-treatment neutrophil levels may benefit from extended (4-cycle) neoadjuvant immunochemotherapy with higher pathologic response rates.