Key result
Neoadjuvant ICIs linked to endocrine irAEs in 27% of patients and more intraoperative hypotension during gastrectomy.
Why the study?
The study was designed to assess endocrine immune-related adverse events induced by neoadjuvant immunotherapy, along with their effects on perioperative endocrine and hemodynamic parameters.
Does neoadjuvant immune checkpoint inhibitor therapy increase perioperative endocrine abnormalities and intraoperative hemodynamic instability in patients undergoing radical gastrectomy?
Cohort (n=960)
Does neoadjuvant immune checkpoint inhibitor therapy increase perioperative endocrine abnormalities and intraoperative hemodynamic instability in patients undergoing radical gastrectomy?
Absolute Event Rate: 24.8% vs 2.1%
p-value: p=<0.001
Neoadjuvant immune checkpoint inhibitors in gastric cancer patients are associated with increased perioperative endocrine dysfunction and, in those who develop endocrine irAEs, greater intraoperative hemodynamic instability.
May warrant preoperative endocrine assessment and intraoperative hemodynamic vigilance after neoadjuvant ICIs; extends irAE risks to perioperative care.
PURPOSE: To assess endocrine immune-related adverse events (irAEs) induced by neoadjuvant immunotherapy, along with effects on perioperative endocrine and hemodynamic parameters. METHODS: Gastric cancer patients undergoing radical gastrectomy between April 2024 and April 2025 were retrospectively reviewed. Those who received neoadjuvant immune checkpoint inhibitors (ICIs) were assigned to the ICIs group. Perioperative parameters were compared after propensity score matching (PSM). A subgroup analysis contrasted endocrine irAE cases with matched controls among ICI-treated patients. RESULTS: In total, 960 patients were included. Endocrine irAEs occurred in 27.0% (83/307) of patients treated with ICIs. After PSM, preoperative endocrine abnormalities were significantly more common in the ICIs group (24.8% [36/145]) than in the non-ICI group (2.1% [3/145]; P < 0.001). No significant differences were observed between groups in intraoperative hemodynamic parameters or postoperative outcomes. Subgroup analysis of ICI-treated patients showed higher incidences of sustained intraoperative hypotension (systolic arterial pressure < 80 mmHg for > 10 min, P = 0.022; mean arterial pressure < 60 mmHg for > 10 min, P = 0.011) in the endocrine irAEs cohort compared with matched controls. Norepinephrine administration was more frequent (3.8% vs. 0.0%; P = 0.043), and intensive care unit (ICU) admission rate was significantly higher (16.5% [13/79] vs. 5.6% [8/144]; P = 0.008). CONCLUSION: Neoadjuvant ICIs are associated with perioperative endocrine dysfunction. Although overall perioperative outcomes remain comparable, intraoperative hemodynamic instability and an elevated ICU admission rate were identified in ICI-treated patients with endocrine irAEs.
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Li et al. (2026) conducted a cohort in Gastric cancer (n=960). Neoadjuvant immune checkpoint inhibitors (ICIs) vs. Non-ICI group was evaluated on Preoperative endocrine abnormalities (p=<0.001). Neoadjuvant immune checkpoint inhibitors were associated with a significantly higher incidence of preoperative endocrine abnormalities compared to no ICIs (24.8% vs 2.1%; P<0.001).
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