Peri-operative Monocyte And Lymphcyte Count Is Associated With Interval Time And Survival Time For Liver Metastases Originating From Gastric Cancer After Radical Gastrectomy

Background and Objective Gastric cancer is one of the most common malignant tumors in the world,ranking the third in cancer-related deaths,which is seriously harmful to human health.There is a obviously high incidence of gastric cancer in China.Its morbidity and mortality are higher than those of western developed countries.Because of the atypical symptoms of early gastric cancer and the lack of universal screening of gastric cancer,gastric cancer in China has developed into advanced gastric cancer at the time of diagnosis,often accompanied by distant lymph node or organ metastasis.The liver is the most frequent site of metastasis in the course of gastric cancer,and the prognosis is generally poor when liver metastasis,but there are still some patients can achieve long-term survival.It is important to select the clinicopathological factors related to long-term survival to predict the prognosis and treatment of gastric cancer patients with liver metastasis.The immune system is involved in the whole process of tumorigenesis and development.It has been confirmed that peripheral monocytes and lymphocytes are related to the prognosis of many kinds of tumors,but the relationship between them and the prognosis of liver metastasis of gastric cancer is not clear.Therefore,the purpose of this study is to explore if peri-operative monocyte and lymphcyte count is associated with interval time and survival time for liver metastases originating from gastric cancer after radical gastrectomy.Methods The clinico-pathological date and postoperative peripheral monocyte andlymphocyte counts of 63 patients with liver metastasis from gastric cancer were retrospectively analyzed.The patients' survival was followed-up.Survival rates were estimate with Kaplan-Meier analysis and compared by Log-rank test.Cox regression model was used to analyze multivariately.Results 63 patients with liver metastasis of gastric cancer were included.27 patients with monocyte increase and 36 patients with monocyte decrease.The median interval time from gastrectomy to liver metastasis was 8.47 months.The difference of the median interval time of liver metastasis between patients with increased or decreased monocyte was statistically significant(11.97 months vs.7.13 months,P < 0.05).Cox analysis showed that the degree of pathological differentiation,N stage,the size of primary focus and the level of monocyte affected the interval time of liver metastasis of gastric cancer(P < 0.05),and the positive lymph node metastasis and the change of monocyte count are independent prognostic factors for the interval time from gastric cancer operation to liver metastasis.Kaplan Meier survival analysis showed that the interval time of liver metastasis in patients with increased monocytes was later than that in patients with decreased monocytes(P < 0.05).There were 23 patients with increased lymphocyte and 40 patients with decreased lymphocyte and the median survival time after liver metastasis was 10.04 months.The median survival time was 11.33 months in patients with lymphocyte increase and 6.93 months in patients with lymphocyte decrease(P< 0.05).Cox analysis showed that the size of the primary gastric cancer,the increased lymphocytes,the number of liver metastases,and the increased Alb in liver metastases were the influencing factors for the prognosis of liver metastases(P < 0.05),and the changes of lymphocyte and the size of primary tumor were independent prognostic factors for survival after liver metastasis.Conclusion Compared with patients with lower peripheral monocyte count after radical gastrectomy,liver metastasis occured later in patients with higher monocyte count.Compared with patients with lower peripheral lymphocyte count after radical gastrectomy,patients with higher lymphocyte count had longer overall survival.