Pretreated baseline neutrophil count and chemotherapy-induced neutropenia may be conveniently available as prognostic biomarkers in advanced gastric cancer.

Abstract

Increasing evidence suggests that neutrophils play a critical role in tumorigenesis, tumour cell proliferation and metastasis. The prognostic significance of such inflammation-associated markers has been explored in different cancers. To evaluate the prognostic effect of baseline neutrophil counts and nadir neutrophils on advanced gastric cancer (AGC) patients who were treated with two different chemotherapy regimens in our institution. Data were collected retrospectively for 260 AGC patients treated between 1 February 2009 and 31 December 2011. The prognostic effect of baseline neutrophil counts and nadir neutrophils on AGC patients was evaluated. Approximately 79% of the patients experienced neutropenia during chemotherapy. The median survival was 369 days for patients with neutrophil counts ≤7.5 × 10(9) /L and 326 days for patients with neutrophil counts >7.5 × 10(9) /L (P < 0.001).The median survival was 340 days for patients with no neutropenia (grade 0), 422 days for patients with mild neutropenia (grade 1-2) and 339 days for patients with severe neutropenia (grade 3-4) (P < 0.001).The adjusted hazard ratios (HR) for mild and severe neutropenia compared with absent neutropenia were 0.572 (P = 0.002) and 1.246 (P = 0.219) respectively. Furthermore, it was suggested that pretreatment baseline neutrophil counts ≤7.5 × 10(9) /L may be an independent predictor (HR = 0.683; P = 0.005). We also observed that other factors were independently associated with worse survival, such as higher performance status, stage IV and the presence of ascites. Our findings suggest that baseline neutrophil count and chemotherapy-induced neutropenia can be conveniently available as clinical biomarkers in AGC. Mild myelosuppression in patients with AGC most likely leads to better overall survival, whereas a high baseline neutrophil count may be associated with a worse prognosis.