J Gastric Cancer.
2020 Jun;20(2):190-201. 10.5230/jgc.2020.20.e21.
Contrasting Prognostic Effects of Tumor-Infiltrating Lymphocyte Density in Cardia and Non-cardia Gastric Adenocarcinomas
- Affiliations
-
- 1Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- 2Gastric Cancer Center, Yonsei Cancer Center, Seoul, Korea
- 3Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
- 4Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
- 5Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
- 6Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Korea
- 7Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- KMID: 2503600
- DOI: http://doi.org/10.5230/jgc.2020.20.e21
Abstract
- Purpose
This study sought to investigate the prognostic significance of tumor-infiltrating lymphocytes (TILs) in relation to tumor location within the stomach.
Materials and Methods
The densities and prognostic significance of TIL subsets were evaluated in 542 gastric cancer patients who underwent gastrectomy. Immunohistochemical staining for CD3, CD4, CD8, forkhead/winged helix transcription factor (Foxp3), and granzyme B was performed.
Results
Cardia cancer was associated with significantly lower densities of CD8 T-cells and higher densities of Foxp3 and granzyme B T-cells than non-cardia tumors. Multivariate analysis showed that advanced age (hazard ratio [HR], 1.023; 95% confidence interval [CI], 1.006–1.040), advanced T classification (HR, 2.029; 95% CI, 1.106–3.721), lymph node metastasis (HR, 3.319; 95% CI, 1.947–5.658), low CD3 expression (HR, 0.997; 95% CI, 0.994–0.999), and a high Foxp3/CD4 ratio (HR, 1.007; 95% CI, 1.001–1.012) were independent predictors of poor overall survival in cardia cancer patients. In non-cardia cancer patients, total gastrectomy (HR, 2.147; 95% CI, 1.507–3.059), advanced T classification (HR, 2.158; 95% CI, 1.425–3.266), lymph node metastasis (HR, 1.854; 95% CI, 1.250–2.750), and a low Foxp3/CD4 ratio (HR, 0.978; 95% CI, 0.959–0.997) were poor prognostic factors for survival.
Conclusions
The densities and prognostic effects of TILs differed in relation to the location of tumors within the stomach. The contrasting prognostic effects of Foxp3/CD4 ratio in cardia and non-cardia gastric cancer patients suggests that clinicians ought to consider tumor location when determining treatment strategies.
