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KMID : 1141820200200020190
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Journal of Gastric Cancer
2020 Volume.20 No. 2 p.190 ~ p.201
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Contrasting Prognostic Effects of Tumor-Infiltrating Lymphocyte Density in Cardia and Non-cardia Gastric Adenocarcinomas
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Kim Hyoung-Il
Kim Sang-Yong
Yu Jae-Eun
Shin Su-Jin
Roh Yun-Ho
Cheong Jae-Ho
Hyung Woo-Jin
Noh Sung-Hoon
Park Chung-Gyu
Lee Hyuk-Joon
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Abstract
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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.
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KEYWORD
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Gastric cancer, Tumor-infiltrating lymphocytes, Tumor location, Cardia, Non-cardia
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