Hua Xiao,1,2,* Peng Zhang,3,* Sheng Zhang,4,* Haifan Xiao,5 Huijun Zhou,6 Dian Liu,7 Zhengchun Wu,1 Jia Luo1 

1Department of Hepatobiliary and Intestinal Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People’s Republic of China; 2Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People’s Republic of China; 3Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 4Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 5Department of Cancer Prevention and Control, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People’s Republic of China; 6Department of Gastroenterology and Urology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People’s Republic of China; 7Department of Lamphoma and Abdominal Radiotherapy, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Jia Luo, Department of Hepatobiliary and Intestinal Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, 283 Tongzipo Road, Changsha, 410013, Hunan, People’s Republic of China, Tel +86 731 89762031, Email luojia@hnca.org.cn

Objective: The aim of this study was to investigate the predictive value of peripheral lymphocyte subsets for prognosis of gastric cancer (GC) patients following radical gastrectomy.
Methods: Consecutive GC patients received curative resection and examined peripheral lymphocyte subsets in Hunan Cancer Hospital were enrolled as training cohort (n=231), and those from Wuhan Union Hospital and Wuhan Tongji Hospital were included as external validation cohort (n=159). The optimal cutoff values of lymphocyte subsets for overall survival (OS) in training cohort were determined by X-tile. The independent predictive factors for OS were identified using univariate and multivariate Cox regression analyses. Furthermore, the predictive value of lymphocyte subsets were evaluated in validation cohort.
Results: The optimal cutoff value of T lymphocytes for OS was 0.84× 109/L in the training cohort. Decreased T lymphocyte (< 0.84× 109/L) were identified as an independent predictor for unfavorable prognosis both in the training and validation cohorts (HR:2.835, 95% CI:1.580– 5.087, P< 0.001; HR:2.470, 95% CI:1.069– 5.711, P=0.034). In the entire cohort, stratified analyses revealed that lower T lymphocyte negatively affected the oncological outcomes in patients with stage II/III disease. A synergistic influence was confirmed in those with decreased T lymphocyte and not received adjuvant chemotherapy (AC). Further analyses revealed that AC significantly prolonged OS in stage II/III patients with decreased T lymphocyte, but not in those with relatively higher T lymphocyte.
Conclusion: Peripheral T lymphocyte numbers was a reliable predictor for OS in GC patients undergoing radical gastrectomy. Additionally, T lymphocyte might serve as an indicator for efficacy of AC in stage II/III GC patients.

Keywords: gastric cancer, gastrectomy, lymphocyte subsets, adjuvant chemotherapy, overall survival