Prognostic value of intratumoral neutrophils in advanced gastric carcinoma in a high-risk area in northern Italy
Prognostic value of intratumoral neutrophils in advanced gastric carcinoma in a high-risk area in northern Italy
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DOI：
10.1097/01.mp.0000020391.98998.6b
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发表时间：
2002-08-01
期刊：
影响因子：
7.5
通讯作者：
Inferrera, C
中科院分区：
文献类型：
--
作者：
Caruso, RA;Bellocco, R;Inferrera, C
若干证据表明，中性粒细胞对肿瘤细胞的作用是非特异性的。肿瘤浸润中性粒细胞（TINs）与临床病理特征之间的相关性仍不明确，值得研究。为了分析TINs对胃癌预后的影响，作者选取了1990年至1995年间在克雷莫纳医院（意大利伦巴第大区）接受胃切除术的273例晚期胃癌患者，并对其进行了为期5年的随访。采用20个非重叠高倍视野（放大倍数为400倍；面积0.08平方毫米）的平均值，以半定量的方式评估TINs的数量。将患者分为两组：TINs数量适中或较多的患者（n = 76；每20个高倍视野中TINs数量>10个）以及TINs数量较少的患者（n = 197；每20个高倍视野中TINs数量≤10个）。采用卡普兰 - 迈耶方法和格林伍德公式来估计两组的粗生存率。基于考克斯比例风险回归模型进行多变量分析，以评估预后因素对生存的影响。在单变量分析所涉及的潜在预后因素中，性别、年龄、肿瘤位置、pTNM分期、TINs以及手术可治愈性与较高的生存率显著相关。对临床病理因素与TINs可能的相互作用效应的研究表明，TINs数量适中或较多的女性患者死亡风险降低了约39%，而男性患者似乎不受TINs水平的影响。这些结果表明，在晚期胃癌中女性的预后似乎比男性好。一些宿主防御机制，特别是中性粒细胞功能方面的性别差异可能是造成这种情况的原因。对这些发现的确认将为宿主对胃癌生长的反应提供有价值的见解，并最终可能对识别可避免辅助治疗的低风险患者产生影响。
Several lines of evidence indicate that neutrophils act nonspecifically against tumor cells. The correlation between tumor-infiltrating neutrophils (TINs) and clinicopathological features remains unclear and deserves to be investigated. To analyze the prognostic influence of TINs in gastric carcinoma, the authors selected 273 patients with advanced gastric carcinoma who underwent gastrectomy at Cremona Hospital (Lombardia, Italy) between 1990 and 1995 and followed them for a period of 5 years. The number of TINs was assessed in a semiquantitative manner using the mean value of 20 nonoverlapping high-power fields (magnification, 400 X; 0.08 mm(2)). The patients were divided into two groups: patients with a moderate or extensive amount of TINs (n = 76; > 10 TINs per 20 high-power fields) and patients with a minor amount of TINs (n = 197; :5 10 TINs per 20 high-power fields). The Kaplan-Meier method and Greenwood formula were used to estimate the crude survival rates in the two groups. Multivariate analyses based on the Cox proportional hazard regression model were performed to assess the effect of the prognostic factors on survival. Among the potential prognostic factors analyzed by univariate analysis, sex, age, location of neoplasia, pTNM stage, TINs, and surgical curability were significantly associated with higher survival rate. The study of the possible interaction effects of the clinical-pathological factors with TINs reveals that female patients with a moderate or extensive amount of TINs have about a 39% reduction in their risk of mortality, whereas male patients do not seem to be affected by the level of TINs. These results suggest that women appear to have a better prognosis than men in advanced gastric carcinoma. Gender differences in some host defense mechanisms and particularly in neutrophil function may be responsible for this event. Confirmation of these findings would give valuable insights about host reaction to gastric cancer growth and, ultimately, possibly would have implications regarding the identification of low-risk patients who could be spared adjuvant therapy.