• Annals of surgery · Feb 2018

    Multicenter Study

    Tumor-infiltrating Neutrophils is Prognostic and Predictive For Postoperative Adjuvant Chemotherapy Benefit in Patients With Gastric Cancer.

    • Heng Zhang, Hao Liu, Zhenbin Shen, Chao Lin, Xuefei Wang, Jing Qin, Xinyu Qin, Jiejie Xu, and Yihong Sun.
    • Department of General Surgery, Zhongshan Hospital of Fudan University, Shanghai, China.
    • Ann. Surg. 2018 Feb 1; 267 (2): 311-318.

    ObjectiveThis study was aimed to investigate the prognostic value of tumor-infiltrating neutrophils (TINs) and to generate a predictive model to refine postoperative risk stratification system for patients with gastric cancer.BackgroundTIN presents in various malignant tumors, but its clinical significance in gastric cancer remains obscure.MethodsThe study enrolled 3 independent sets of patients with gastric cancer from 2 institutional medical centers of China. TIN was estimated by immunohistochemical staining of CD66b, and its relationship with clinicopathological features and clinical outcomes were evaluated. Prognostic accuracies were evaluated by C-index and Akaike information criterion.ResultsTINs in gastric cancer tissues ranged from 0 to 192 cells/high magnification filed (HPF), 0 to 117 cells/HPF, and 0 to 142 cells/HPF in the training, testing, and validation sets, respectively. TINs were negatively correlated with lymph node classification (P = 0.007, P = 0.041, and P = 0.032, respectively) and tumor stage (P = 0.019, P = 0.013, and P = 0.025, respectively) in the 3 sets. Moreover, multivariate analysis identified TINs and tumor node metastasis (TNM) stage as 2 independent prognostic factors for overall survival. Incorporation of TINs into well-established TNM system generated a predictive model that shows better predictive accuracy for overall survival. More importantly, patients with higher TINs were prone to overall survival benefit from postoperative adjuvant chemotherapy. These results were validated in the independent testing and validation sets.ConclusionsTIN in gastric cancer was identified as an independent prognostic factor, which could be incorporated into standard TNM staging system to refine risk stratification and predict for overall survival benefit from postoperative chemotherapy in patients with gastric cancer.

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