Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2015; 21(9): 2668-2676
Published online Mar 7, 2015. doi: 10.3748/wjg.v21.i9.2668
Absolute monocyte and lymphocyte count prognostic score for patients with gastric cancer
Wan Kyu Eo, Da Wun Jeong, Hye Jung Chang, Kyu Yeoun Won, Sung Il Choi, Se Hyun Kim, Sung Wook Chun, Young Lim Oh, Tae Hwa Lee, Young Ok Kim, Ki Hyung Kim, Yong Il Ji, Ari Kim, Heung Yeol Kim
Wan Kyu Eo, Da Wun Jeong, Hye Jung Chang, Department of Hematology/Medical Oncology, Kyung Hee University Hospital at Gangdong, Seoul 134727, South Korea
Kyu Yeoun Won, Department of Pathology, Kyung Hee University Hospital at Gangdong, Seoul 134727, South Korea
Sung Il Choi, Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul 134727, South Korea
Se Hyun Kim, Graduate School, Dankuk University, Yongin 448701, South Korea
Sung Wook Chun, Yong Il Ji, Department of Obstetrics and Gynecology, Inje University College of Medicine, Busan 612896, South Korea
Young Lim Oh, Tae Hwa Lee, Heung Yeol Kim, Department of Obstetrics and Gynecology, Kosin University College of Medicine, Busan 602702, South Korea
Young Ok Kim, Department of Pathology, Kosin University College of Medicine, Busan 602702, South Korea
Ki Hyung Kim, Department of Obstetrics and Gynecology, Pusan National University Hospital, Pusan National University School of Medicine, and Biomedical Research Institute and Pusan Cancer Center, Busan 602739, South Korea
Ari Kim, Department of Obstetrics and Gynecology, Institute of Wonkwang Medical Science, College of Medicine, Wonkwang University, Iksan 570749, South Korea
Author contributions: Kim A and Kim HY carried out a role as co-corresponding authors equally; Eo WK and Kim HY designed the research; Choi SI performed Patient Recruitment; Jeong DW and Chang HJ performed data collection; Won KY and Kim YO performed data interpretation as responsible pathologists; Oh YL, Lee TH, Kim KH, Ji YI and Kim A analyzed the data and reviewed manuscript; Kim SH performed statistical analysis; Eo WK and Chun SW wrote the paper.
Supported by Kyung Hee University in 2006, No. KHU-20061216.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Heung Yeol Kim, MD, PhD, Department of Obstetrics and Gynecology, Kosin University College of Medicine, 34, Amnam-dong, Seo-gu, Busan 602702, South Korea. hykyale@yahoo.com
Telephone: +82-51-9906226 Fax: +82-51-9903300
Received: August 19, 2014
Peer-review started: August 20, 2014
First decision: September 27, 2014
Revised: October 16, 2014
Accepted: December 5, 2014
Article in press: December 8, 2014
Published online: March 7, 2015
Processing time: 202 Days and 8.2 Hours
Abstract

AIM: To measure the prognostic significance of absolute monocyte count/absolute lymphocyte count prognostic score (AMLPS) in patients with gastric cancer.

METHODS: We retrospectively examined the combination of absolute monocyte count (AMC) and absolute lymphocyte count (ALC) as prognostic variables in a cohort of 299 gastric cancer patients who underwent surgical resection between 2006 and 2013 and were followed at a single institution. Both AMC and ALC were dichotomized into two groups using cut-off points determined by receiving operator characteristic curve analysis. An AMLPS was generated, which stratified patients into three risk groups: low risk (both low AMC and high ALC), intermediate risk (either high AMC or low ALC), and high risk (both high AMC and low ALC). The primary objective of the study was to validate the impact of AMLPS on both disease-free survival (DFS) and overall survival (OS), and the second objective was to assess the AMLPS as an independent prognostic factor for survival in comparison with known prognostic factors.

RESULTS: Using data from the entire cohort, the most discriminative cut-off values of AMC and ALC selected on the receiver operating characteristic curve were 672.4/μL and 1734/μL for DFS and OS. AMLPS risk groups included 158 (52.8%) patients in the low-risk, 128 (42.8%) in the intermediate-risk, and 13 (4.3%) in the high-risk group. With a median follow-up of 37.2 mo (range: 1.7-91.4 mo), five-year DFS rates in the low-, intermediate-, and high-risk groups were 83.4%, 78.7%, and 19.8%, respectively. And five-year OS rates in the low-, intermediate-, and high-risk groups were 89.3%, 81.1%, and 14.4%, respectively. On multivariate analysis performed with patient- and tumor-related factors, we identified AMLPS, age, and pathologic tumor-node-metastasis stage as the most valuable prognostic factors impacting DFS and OS.

CONCLUSION: AMLPS identified patients with a poor DFS and OS, and it was independent of age, pathologic stage, and various inflammatory markers.

Keywords: Monocytes; Absolute lymphocyte count; Stomach neoplasms

Core tip: Our findings suggest that the absolute monocyte count (AMC) and absolute lymphocyte count (ALC) prognostic score combined by AMC and ALC can predicts survival and identify gastric cancer patients with a poor overall survival, and this prognostic score is independent of age, pathologic stage, and various inflammatory markers.