Expression Of Autophagy-Related Proteins Is Associated With The Clinical Outcome Of Patients With Advanced Gastric Cancer Receiving Fluoropyrimidine/Platinum Chemotherapy

The precise prediction of the clinical outcome of cancer patients is crucial for determining therapeutic options and providing optimal cancer care. Although targeted therapy is widely used in cancer treatment, chemotherapy remains the first-line treatment for patients with advanced gastric cancer. This study aimed to investigate the expression of autophagy-related proteins, unc-51-like kinase 1 (ULK1) and beclin 1 (BECN1), in advanced gastric cancer to clarify their clinical significance in the prognosis assessment of patients receiving fluoropyrimidine/platinum chemotherapy. The expression levels of ULK1 and BECN1 in gastric cancer tissues from 149 patients with TNM stages III and IV were measured by immunohistochemical staining. Both ULK1 and BECN1 were upregulated in gastric cancer. High expression of ULK1 and BECN1 were associated with older age and poor differentiation, respectively. In the univariate survival analysis, ULK1 and BECN1 expression were identified as predictors of poor prognosis. Only BECN1 expression was independently associated with poor prognosis in multivariate analysis. This association was significantly evident in cases who were older than 65 years, male, never smokers, drinkers, and those with poor differentiation or TNM stage III. Furthermore, the combined analysis revealed a significant cumulative effect on overall survival. Taken together, the expression levels of autophagy-related proteins could predict clinical benefit of fluoropyrimidine/platinum chemotherapy in patients with advanced gastric cancer.