There is growing consensus that host immunity, of which lymphocytes are well-known as an indicator, plays important roles against the development of malignancy. Based on this concept, many studies reported the prognostic value of preoperative markers related to lymphocytes. This study aimed to investigate the prognostic value of pre- and postoperative lymphocyte counts and representative markers related to lymphocytes in predicting overall survival (OS) in patients with gastric cancer.
A total of 177 consecutive patients who underwent curative gastrectomy for pStage II or III gastric cancer from 2010 to 2014 were enrolled. We evaluated pre- and postoperative lymphocytes and representative markers including neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR), and prognostic nutrition index (PNI). The optimal cutoff values of them were determined using the receiver operating characteristic (ROC) curve analysis. Prognostic value of them were analyzed using both Kaplan-Meier and multivariate Cox regression methods.
Elevated pre- and postoperative lymphocytes, especially postoperative lymphocytes tended to be associated with better OS when classified into three groups [5-year OS: 46.2% in low-group (<1000), 62.5% in middle-group (1000-2000), and 80.9% in high-group (≥2000)]. ROC analysis revealed a higher predictive power for recurrence with the postoperative markers compared with preoperative ones. Postoperative lymphocyte (>1400), NLR (<2.3), LMR (>2.8), PLR (<150), and PNI (>47.0) were significantly associated with better OS (P < 0.001, P < 0.001, P = 0.007, P = 0.001, and P < 0.001, respectively). Of these markers, postoperative PNI (>47.0) was most associated with better OS on each pStage (P = 0.003 on pStage II, and P = 0.070 on pStage III). Multivariate analysis revealed that postoperative PNI (>47.0) and pN(-) were independent prognostic factors for OS.
Postoperative markers related to lymphocytes could have higher predictive power compared with preoperative ones, and postoperative PNI may be a better predictor of OS in patients with gastric cancer.
Clinical trial identification
Legal entity responsible for the study
The Supporting Center for Clinical research and Education (SCCRE).
Has not received any funding.
All authors have declared no conflicts of interest.