Division of Gastrointestinal Surgery, Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Ann Surg Oncol. 2024 Oct;31(10):6951-6958. doi: 10.1245/s10434-024-15874-w. Epub 2024 Aug 1.
Several studies have found that the absolute lymphocyte (ALC) or neutrophil count predicts the survival of patients with solid tumors, and that the neutrophil-to-lymphocyte ratio and the prognostic nutritional index are useful markers of gastric cancer prognosis. However, it remains unclear whether the ALC is prognostic of lymph node (LN) metastasis in patients with gastric cancer. In this study, we aimed to explore the impact of ALC on prognosis and distinctive clinical characteristics in patients with gastric cancer.
The medical records of patients with gastric adenocarcinomas who underwent radical gastrectomy with curative intent at Seoul St. Mary's Hospital and Yeouido St. Mary's Hospital between January 2010 and December 2017 were reviewed. Of these, 4149 patients for whom preoperative white blood cell, neutrophil, and lymphocyte counts were available were enrolled.
In all 4149 patients, ALC gradually decreased as the pN stage increased. Those with an ALC of less than 1360 cells/μL were defined as a low-ALC group, and advanced cT and cN stages were the strongest risk factors for LN metastasis in both univariate and multivariate analyses; undifferentiated tumor histology and a low ALC were also significant risk factors. Patients of all stages in the ALC-low group exhibited poorer prognoses. The ALC-low group also exhibited a higher recurrence rate in a greater proportion of LNs.
In patients with gastric cancer, as the preoperative ALC decreases, the incidence of LN metastasis increases. A low ALC is associated with a high recurrence rate, particularly in LNs.
多项研究发现，绝对淋巴细胞（ALC）或中性粒细胞计数可预测实体瘤患者的生存情况，中性粒细胞与淋巴细胞比值和预后营养指数是胃癌预后的有用标志物。然而，ALC 是否对胃癌患者的淋巴结（LN）转移具有预后意义尚不清楚。本研究旨在探讨 ALC 对胃癌患者预后和临床特征的影响。
回顾性分析 2010 年 1 月至 2017 年 12 月期间在首尔圣玛丽医院和汝矣岛圣玛丽医院接受根治性胃切除术的胃腺癌患者的病历资料。共纳入 4149 例术前白细胞、中性粒细胞和淋巴细胞计数均可用的患者。
在所有 4149 例患者中，ALC 随 pN 分期的增加而逐渐降低。将 ALC 低于 1360 个细胞/μL 的患者定义为低 ALC 组，单因素和多因素分析均显示，较高的 cT 和 cN 分期是 LN 转移的最强危险因素；未分化的肿瘤组织学和低 ALC 也是显著的危险因素。低 ALC 组各分期患者的预后均较差。低 ALC 组的 LN 复发率也更高。
在胃癌患者中，随着术前 ALC 的降低，LN 转移的发生率增加。低 ALC 与较高的复发率相关，尤其是在 LN 中。
