Lymphocytes are an important portion of the cell-mediated immune system, and play a significant role in immune responses to cancer. We investigated whether peripheral lymphocyte are associated with disease-free survival, gastric cancer-specific survival, and overall survival in surgically resected gastric cancer.
We retrospectively evaluated stage II-III gastric cancer patients who underwent curative surgical resection to analyze correlations among absolute lymphocyte counts and prognosis. Multivariable regression models adjusted for age, performance status, cancer stage, neoadjuvant/adjuvant chemotherapy use, HER2 expression were used to evaluate associations between absolute lymphocyte count, disease-free survival, gastric cancer-specific overall survival, and overall survival.
A total of 338 stage II-III gastric cancer patients were diagnosed from January 2011 to December 2015. At the time of diagnosis, lymphopenic were 31 (9.1%) and no patients were neutropenic. Nearly one quarter (25.1%) were ever neutropenic (ANC <1.0 K/μL) and nearly half (52.6%) were lymphopenic (ALC <1.0 K/μL) with a mean minimum ALC value of 1.00 K/μL. On multivariable analysis, ever lymphopenia predicted higher recurrence rate [HR = 12.4; 95% CI 4.9-31.3], higher gastric cancer-specific mortality [HR = 22.7; 95% CI 6.5-79.1], and higher overall mortality [HR = 36.6; 95% CI 10.3-130.0]. Five year disease-free survival was 57% for patients who were ever lymphopenic versus 96% for those who were not. Fiver year gastric cancer specific overall survival was 65% versus 98% for ever lymphopenic and never lymphopenic patients, respectively.
Higher peripheral lymphocyte counts predicted lower recurrence rate and better overall survival from potentially curable gastric cancer, suggesting that immune function may enhance the effectiveness of non-advanced gastric cancer treatment.
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