title: Prognostic value of perioperative leukocyte count in resectable gastric cancer.
abstract: OBJECTIVE
  To investigate the prognostic significance of perioperative leukopenia in patients with resected gastric cancer.
  
  
  METHODS
  A total of 614 eligible gastric cancer patients who underwent curative D2 gastrectomy and adjuvant chemotherapy were enrolled in this study. The relationship between pre- and postoperative hematologic parameters and overall survival was assessed statistically, adjusted for known prognostic factors.
  
  
  RESULTS
  The mean white blood cell count (WBC) significantly decreased after surgery, and 107/614 (17.4%) patients developed p-leukopenia, which was defined as a preoperative WBC ≥ 4.0 × 10(9)/L and postoperative WBC < 4.0 × 10(9)/L, with an absolute decrease ≥ 0.5 × 10(9)/L. The neutrophil count decreased significantly more than the lymphocyte count. P-leukopenia significantly correlated with poor tumor differentiation and preoperative WBC. A higher preoperative WBC and p-leukopenia were independent negative prognostic factors for survival [hazard ratio (HR) = 1.602, 95% confidence interval (CI): 1.185-2.165; P = 0.002, and HR = 1.478, 95%CI: 1.149-1.902; P = 0.002, respectively] after adjusting for histology, Borrmann type, pTNM stage, vascular or neural invasion, gastrectomy method, resection margins, chemotherapy regimens, and preoperative WBC count. The patients with both higher preoperative WBC and p-leukopenia had a worse prognosis compared to those with lower baseline WBC and no p-leukopenia (27.5 mo vs 57.3 mo, P < 0.001).
  
  
  CONCLUSIONS
  Preoperative leukocytosis alone or in combination with postoperative leukopenia could be independent prognostic factors for survival in patients with resectable gastric cancer.
authors.affiliation: Xiao-Feng Chen, Jing Qian, Dong Pei, Chen Zhou, Fang Zhu, Shao-Hua He, Ying-Ying Qian, Yue Zhou, Jun Xu, Yi-Qian Liu, Ren-Hua Guo, Yong-Qian Shu, Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Chen
authors.affiliation: Xiao-Feng Chen, Jing Qian, Dong Pei, Chen Zhou, Fang Zhu, Shao-Hua He, Ying-Ying Qian, Yue Zhou, Jun Xu, Yi-Qian Liu, Ren-Hua Guo, Yong-Qian Shu, Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Qian
authors.affiliation: Xiao-Feng Chen, Jing Qian, Dong Pei, Chen Zhou, Fang Zhu, Shao-Hua He, Ying-Ying Qian, Yue Zhou, Jun Xu, Yi-Qian Liu, Ren-Hua Guo, Yong-Qian Shu, Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Pei
authors.affiliation: Xiao-Feng Chen, Jing Qian, Dong Pei, Chen Zhou, Fang Zhu, Shao-Hua He, Ying-Ying Qian, Yue Zhou, Jun Xu, Yi-Qian Liu, Ren-Hua Guo, Yong-Qian Shu, Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Xiao-Feng Chen, Jing Qian, Dong Pei, Chen Zhou, Fang Zhu, Shao-Hua He, Ying-Ying Qian, Yue Zhou, Jun Xu, Yi-Qian Liu, Ren-Hua Guo, Yong-Qian Shu, Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Oluf Dimitri
authors.initials: OD
authors.lastname: Røe
authors.affiliation: Xiao-Feng Chen, Jing Qian, Dong Pei, Chen Zhou, Fang Zhu, Shao-Hua He, Ying-Ying Qian, Yue Zhou, Jun Xu, Yi-Qian Liu, Ren-Hua Guo, Yong-Qian Shu, Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Zhu
authors.affiliation: Xiao-Feng Chen, Jing Qian, Dong Pei, Chen Zhou, Fang Zhu, Shao-Hua He, Ying-Ying Qian, Yue Zhou, Jun Xu, Yi-Qian Liu, Ren-Hua Guo, Yong-Qian Shu, Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Shao-Hua
authors.initials: SH
authors.lastname: He
authors.affiliation: Xiao-Feng Chen, Jing Qian, Dong Pei, Chen Zhou, Fang Zhu, Shao-Hua He, Ying-Ying Qian, Yue Zhou, Jun Xu, Yi-Qian Liu, Ren-Hua Guo, Yong-Qian Shu, Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Ying-Ying
authors.initials: YY
authors.lastname: Qian
authors.affiliation: Xiao-Feng Chen, Jing Qian, Dong Pei, Chen Zhou, Fang Zhu, Shao-Hua He, Ying-Ying Qian, Yue Zhou, Jun Xu, Yi-Qian Liu, Ren-Hua Guo, Yong-Qian Shu, Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Xiao-Feng Chen, Jing Qian, Dong Pei, Chen Zhou, Fang Zhu, Shao-Hua He, Ying-Ying Qian, Yue Zhou, Jun Xu, Yi-Qian Liu, Ren-Hua Guo, Yong-Qian Shu, Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Xu
authors.affiliation: Xiao-Feng Chen, Jing Qian, Dong Pei, Chen Zhou, Fang Zhu, Shao-Hua He, Ying-Ying Qian, Yue Zhou, Jun Xu, Yi-Qian Liu, Ren-Hua Guo, Yong-Qian Shu, Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Xu
authors.affiliation: Xiao-Feng Chen, Jing Qian, Dong Pei, Chen Zhou, Fang Zhu, Shao-Hua He, Ying-Ying Qian, Yue Zhou, Jun Xu, Yi-Qian Liu, Ren-Hua Guo, Yong-Qian Shu, Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Li
authors.affiliation: Xiao-Feng Chen, Jing Qian, Dong Pei, Chen Zhou, Fang Zhu, Shao-Hua He, Ying-Ying Qian, Yue Zhou, Jun Xu, Yi-Qian Liu, Ren-Hua Guo, Yong-Qian Shu, Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Guo-Qiang
authors.initials: GQ
authors.lastname: Ping
authors.affiliation: Xiao-Feng Chen, Jing Qian, Dong Pei, Chen Zhou, Fang Zhu, Shao-Hua He, Ying-Ying Qian, Yue Zhou, Jun Xu, Yi-Qian Liu, Ren-Hua Guo, Yong-Qian Shu, Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Yi-Qian
authors.initials: YQ
authors.lastname: Liu
authors.affiliation: Xiao-Feng Chen, Jing Qian, Dong Pei, Chen Zhou, Fang Zhu, Shao-Hua He, Ying-Ying Qian, Yue Zhou, Jun Xu, Yi-Qian Liu, Ren-Hua Guo, Yong-Qian Shu, Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Wang
authors.affiliation: Xiao-Feng Chen, Jing Qian, Dong Pei, Chen Zhou, Fang Zhu, Shao-Hua He, Ying-Ying Qian, Yue Zhou, Jun Xu, Yi-Qian Liu, Ren-Hua Guo, Yong-Qian Shu, Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Ren-Hua
authors.initials: RH
authors.lastname: Guo
authors.affiliation: Xiao-Feng Chen, Jing Qian, Dong Pei, Chen Zhou, Fang Zhu, Shao-Hua He, Ying-Ying Qian, Yue Zhou, Jun Xu, Yi-Qian Liu, Ren-Hua Guo, Yong-Qian Shu, Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Yong-Qian
authors.initials: YQ
authors.lastname: Shu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D007964:Leukocytosis / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D007970:Leukopenia / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D059035:Perioperative Period; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Gastric cancer; Leukocytosis; Leukopenia; Postoperative; Prognosis