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The prognositc value of lymphopenia in advanced gastric cancer.

e14500 Background: Although a few histologic and biologic markers in advanced cancers are suggested to predict overall survival, the prognostic marker of stage IV AGC is unknown. While lymphopenia is known to be a prognostic marker in advanced sarcoma and non-Hodgkin lymphoma, its role in AGC has not been elucidated. There are some theories that low absolute lymphocyte count (ALC) may be associated with immune status or consequence of lympholytic cytokines produced by the lymphoma cells. Thus, we studied the role of ALC at diagnosis with clinical outcome in stage IV AGC.


METHODS
We analyzed the prognostic value of ALC in 129 patients diagnosed with advanced gastric cancer. The median age of 54 (range 24-86) years. Median ALC at the time of diagnosis was 1670 (range 309-12,340/μL). Patients were divided into two groups according to ALC count 1,500/μL. The median ALC level was 1,090/μL (range, 300-1,480/μL) in the low ALC group (N = 50) and 2,220/μL (range, 1,530-12,340/μL) in high ALC group (N=79). Lymphopenia was not statistically different from any clinical variables such as gender, age, histologic subtype and metastatic sites. Median follow-up duration was 12 months (range 0.2-75.6 months).


RESULTS
Overall survival was higher in patients with ALC >1,500/μL compared to those with ALC < 1,500/μL (median OS: 16.2 months vs 8.1 months, p=0.008). In the univariate analysis, bone metastasis and peritoneal metastasis were associated with overall survival (p<0.001, p<0.002, respectively). The median ALC was low in patients with bone metastasis compared with no metastasis patients (1,385/μL (309-2,330/μL) vs 1840/μL (620-12,340/μL), p=0.034). In the multivariate analysis, low ALC was an independent poor prognostic factor for overall survival (p = 0.046, 95% CI, 1.170-2.573) (Hazard Ratio 1.7, 95% confidence intervals 1.1?2.5; p<0.007), along with bone (HR 3.57, 95% CI 1.89-6.75 p < 0.001) and peritoneal metastasis (HR 1.68, 95% CI 1.12-2.5 p < 0.001).


CONCLUSIONS
This study suggests that low ALC is an independent prognostic factor of overall survival in patients with stage IV AGC. As lymphopenia is associated with bone metastasis, we suggest AGC patients with low ALC count undergo skeletal survey.