CD14 monocyte PD-L1 and VEGF-A reductions are associated with improved survival after sintilimab plus DOX in advanced gastric cancer

OBJECTIVE: To evaluate the efficacy and safety of sintilimab plus docetaxel, oxaliplatin, and capecitabine (DOX) chemotherapy in advanced gastric cancer and explore whether dynamic peripheral immune-inflammatory and angiogenesis-related biomarker changes were associated with survival benefit. MATERIALS AND METHODS: This single-center retrospective cohort study included 80 patients with advanced gastric cancer treated between June 2021 and June 2022. Patients received either DOX alone or sintilimab plus DOX chemotherapy, with 40 patients in each group. Tumor response, progression-free survival (PFS), overall survival (OS), 36-month OS rate, serum tumor markers, immune-inflammatory indicators, angiogenesis-related biomarkers, and treatment-related adverse events were compared. Dynamic biomarker changes were defined as post-treatment values minus baseline values. Adjusted Cox regression and ROC analyses were performed. RESULTS: monocyte PD-L1 expression and VEGF-A were independently associated with improved PFS and OS. The combined biomarker model showed moderate performance for predicting 36-month OS. Adverse event rates were comparable between groups. CONCLUSION: monocyte PD-L1 expression and VEGF-A may indicate survival benefit.