Abstract
This study was designed to investigate the prognostic value of circulating blood cell counts and subsets for patients with advanced gastric cancer (AGC) treated with neoadjuvant chemotherapy (NAC) and the factors determining pathological complete response (pCR). In 112 patients with AGC, we retrospectively examined the ratios of lymphocyte, monocyte, and neutrophil during and after NAC before surgery, and the percentages of CD3+, CD3+ CD4+, CD3+ CD8+ and CD4+/CD8+ lymphocytes as well. We also investigated their associations with the pCR rate and overall survival (OS). The ratios of lymphocyte taken before and after NAC were significantly greater in forty-four pCR cases than that in sixty-eight non-pCR cases. During NAC, the proportion of lymphocyte and the percentages of CD3+, CD3+ CD4+, and CD3+ CD8+ lymphocytes were dramatically increased in pCR group. The lymphocyte ratio showed an independent association with pCR by multivariate analysis and maintained at a relatively high level in pCR cases. By mean of 31.53% lymphocyte ratio before-NAC and 41.68% after-NAC, cases with high lymphocyte ratio showed significantly better outcome in OS. High circulating lymphocyte ratios, both before and after NAC, are positively associated with pCR and improved OS in advanced gastric cancer, which may be considered as a new prognostic biomarker.
Highlights
Gastric cancer remains one of the most common malignancies around the world and causes 499,000 cancer-related deaths each year in China[1,2,3,4]
Since blood cell counts in peripheral blood were considered to reflect the immunological function in advanced gastric cancer (AGC) patients, we have endeavored to determine whether the values of lymphocytes before or after Neoadjuvant chemotherapy (NAC) may serve as new parameters predicting pathological complete response (pCR) to NAC
We clarified that the pCR rate for patients with AGC underwent NAC was approximate 17.7%, which was higher than other reports (8.4–17.4%)[13,14,24,25,26]
Summary
Gastric cancer remains one of the most common malignancies around the world and causes 499,000 cancer-related deaths each year in China[1,2,3,4]. The pathological complete response (pCR) to NAC has been reported to correlate with a favorable long-term outcome[13,14,15,16]. It turns out rarely in patients with AGC, despite the application of various combined chemotherapy regimens. A recent meta-analysis study[21] has shown that the elevated platelet to lymphocyte ratio could be a significant prognostic biomarker for poor overall survival (OS) in patients with gastric cancer. Since blood cell counts in peripheral blood were considered to reflect the immunological function in AGC patients, we have endeavored to determine whether the values of lymphocytes before or after NAC may serve as new parameters predicting pCR to NAC.
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