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

Background and aim: 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. Methods: 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. Results: < 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). Conclusions: Increased SV is associated with poorer clinical outcomes in advanced gastric cancer patients receiving chemotherapy combined with immunotherapy.