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Early myelostimulation in patients with locally advanced gastric cancer after fluorouracil plus platinum-based neoadjuvant chemotherapy is related to poor prognosis

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Abstract

Purpose

Some cancer patients experience an increase in the leukocyte count, platelet count, and absolute neutrophil count compared to the baseline level after chemotherapy. We identify this phenomenon as "myelostimulation", which seems to go against the myelosuppression properties of chemotherapy drugs. However, the clinical value of "myelostimulation" that appears early after fluorouracil plus platinum-based neoadjuvant chemotherapy (NACT) in patients with locally advanced gastric cancer (LAGC) remains unclear.

Method

Patients with LAGC who underwent fluorouracil plus platinum-based NACT and radical resection from January 2010 to January 2015 were included. Patients were divided into an increased group and a decreased group based on the leukocyte count, platelet count, and absolute neutrophil count in the early stage after NACT, compared with the baseline blood routine examination results. The prognosis was compared between the increased group and the decreased group.

Results

The 3-year PFS and 5-year OS of the group with increased leukocyte count, platelet count, and absolute neutrophil count were significantly lower compared to those of the decreased group. Based on the multivariate analysis, increased absolute neutrophil count is an independent risk factor for 3-year PFS (P < 0.001, HR 3.003, 95% CI 1.639–5.495) and 5-year OS (P = 0.003, HR 2.611, 95% CI 1.374–4.950), and increased platelet count is an independent risk factor for 5-year OS (P = 0.037, HR 2.033, 95% CI 1.044–3.953).

Conclusion

The "myelostimulation" that occurs in patients with LAGC in the early stage (3–5 days) after fluorouracil plus platinum-based NACT is related to a poor prognosis, which is a simple and effective method to screen related patients with unfavored outcomes. Notably, the increase in absolute neutrophil count and platelet count has been proved to be an independent risk factor.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China

    Yang Liu, Yongde Cao, Leting Xiao & Haijiang Wang

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  1. Yang Liu
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  2. Yongde Cao
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Contributions

YL designed the work. YL, YC and LX analyzed and interpreted the patient data. YL and HW were major contributors in writing the manuscript. All authors read and approved the final manuscript.

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Correspondence to Haijiang Wang.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. The exemption from informed consent requirement was permitted by The Affiliated Cancer Hospital of Xinjiang Medical University Institutional Review Board.

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Liu, Y., Cao, Y., Xiao, L. et al. Early myelostimulation in patients with locally advanced gastric cancer after fluorouracil plus platinum-based neoadjuvant chemotherapy is related to poor prognosis. Cancer Chemother Pharmacol 87, 701–710 (2021). https://doi.org/10.1007/s00280-021-04243-z

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