Abstract
The consensus of endoscopic therapy for early gastric cancer (EGC) mainly depends on its clinicopathological features. However, the roles of tumor-associated neutrophils (TANs) in EGC remain uncertain. Here, we explored its predictive role for lymph node metastasis (LNM) in EGC. Three hundred twenty-two patients who underwent radical gastrectomy for EGC were enrolled. Preoperative peripheral blood was used to analyze the neutrophil-to-lymphocyte ratio (NLR), and the different status of TANs was determined by hematoxylin-and-eosin staining (H&E) and immunohistochemistry (IHC). TANs, rather than NLR, were positively associated with tumor size, Lauren classification, lymphovascular invasion (LVI), and LNM. Univariate analysis revealed that TANs were associated with LNM as well as tumor size, depth of invasion, Lauren classification, histological classification, LVI, and perineural invasion. In addition to histological classification and LVI, TANs were found to be an independent risk factor for LNM in EGC (P = 0.013). Stratification analysis by depth of invasion showed LVI in SM1 tumor, and both LVI and TANs (P = 0.042) in SM2 tumor were independent risk factors for LNM. In conclusion, TANs in EGC can predict LNM, and TANs may help to estimate LNM precisely in addition to the current criteria.
Highlights
Gastric cancer is one of the most lethal malignant diseases worldwide, especially in China, ranking second in the incidence and third in the mortality of all malignant tumors [1, 2]
We investigated the clinicopathological significance of tumor-associated neutrophils (TANs) and Cancer-associated fibroblasts (CAFs) in early gastric cancer (EGC)
We revealed that TANs and CAFs, rather than peripheral blood neutrophil count and neutrophil-to-lymphocyte ratio (NLR), were positively associated with clinicopathological features including tumor size, Lauren classification, lymphovascular invasion (LVI), and lymph node metastasis (LNM)
Summary
Gastric cancer is one of the most lethal malignant diseases worldwide, especially in China, ranking second in the incidence and third in the mortality of all malignant tumors [1, 2]. The incidence of early gastric cancer (EGC) has been increasing in the past decades with the enhanced public awareness of this disease and the development of screening technologies. Three evaluation categories (absolute, expanded, and relative indications or endoscopic curability A, B, and C) are used to guide endoscopic therapy for EGC depending on the TANs Predict LNM in EGC incidence of LNM and completeness of the primary tumor removal [5, 6]. Endoscopic therapy has some pitfalls for EGC according to these current guidelines. Seeking a more precise indicator for LNM is compelling for EGC
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