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. 2020 Jan;9(1):280-293.
doi: 10.21037/tcr.2019.12.68.

Neoadjuvant chemotherapy-induced severe neutropenia is associated with histopathological response and survival in locally advanced gastric cancer

Chaorui Wu  1 , Tongbo Wang  1 , Hong Zhou  1 , Xiaojie Zhang  1 , Chunguang Guo  1 , Yingtai Chen  1 , Dongbing Zhao  1
Affiliations

Neoadjuvant chemotherapy-induced severe neutropenia is associated with histopathological response and survival in locally advanced gastric cancer

Chaorui Wu et al. Transl Cancer Res. 2020 Jan.

Abstract

Background: Neoadjuvant chemotherapy (NAC) has been shown to improve the prognosis for patients with locally advanced gastric cancer (LAGC). Neutropenia, a predominant chemotherapy-related adverse event, affects the therapeutic course for NAC.

Methods: Data for 233 patients with LAGC treated with NAC and curative gastrectomy at our center were retrospectively analysed in terms of the relationship between neutropenia and clinicopathological features or outcomes.

Results: NAC-induced neutropenia, NAC-induced severe (grade 3/4) neutropenia (NISN), and a favorable histopathological response (HPR) were observed in 102 (43.8%), 35 (15.0%), and 103 (44.2%) patients, respectively. Together with tumor differentiation, clinical response, and lymphovascular invasion (LVI), and NISN independently predicted a favorable HPR [odds ratio (OR) =4.158, 95% confidence interval (CI): 1.762-9.812, P=0.001). Among patients treated with postoperative chemotherapy, NISN independently predicted poor compliance with postoperative chemotherapy (OR 0.364, 95% CI: 0.148-0.894, P=0.028) and thus poor overall survival (OS) and disease-free survival (DFS). Among patients treated with preoperative chemotherapy alone, NISN was associated with a tendency towards a better DFS (P=0.116) and independently predicted superior OS (hazard ratio =0.253, 95% CI: 0.077-0.830, P=0.023).

Conclusions: In conclusion, our study revealed a link between NISN, HPR, treatment compliance, and survival. NISN is useful for guiding treatment strategies and predicting prognosis for LAGC patients.

Keywords: Neutropenia; gastric cancer; histopathological response (HPR); neoadjuvant chemotherapy (NAC); prognosis.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tcr.2019.12.68). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Survival curves for overall survival and disease-free survival of patients according to neutropenia grade in the entire cohort (A,B), those treated with pre- and postoperative chemotherapy (C,D), and preoperative chemotherapy alone (E,F). HR, hazard ratio; CI, confidence interval.
Figure 2
Figure 2
Subgroup analyses of overall survival.
Figure S1
Figure S1
Results of tumor regression grade (TRG) and degree of neoadjuvant chemotherapy (NAC)-induced neutropenia. Proportions of patients with grade 0–2 or grade 3/4 neutropenia according to TRG category.
Figure S2
Figure S2
Subgroup analyses of disease-free survival.
See this image and copyright information in PMC

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