Contrasting prognostic effects of tumor-infiltrating lymphocyte density in cardia and non-cardia gastric adenocarcinomas

Hyoung Il Kim, Sang Yong Kim, Jae Eun Yu, Su Jin Shin, Yun Ho Roh, Jae Ho Cheong, Woo Jin Hyung, Sung Hoon Noh, Chung Gyu Park, Hyuk Joon Lee

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


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.

Original languageEnglish
Pages (from-to)190-201
Number of pages12
JournalJournal of Gastric Cancer
Issue number2
Publication statusPublished - 2020 Jun

Bibliographical note

Funding Information:
This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korea Government (MSIT) (No. 2019R1H1A2079953) and a faculty research grant from Yonsei University College of Medicine (6-2016-0087). The funding agencies had no role in the study design; the collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the article for publication.

Publisher Copyright:
Copyright © 2020. Korean Gastric Cancer Association.

All Science Journal Classification (ASJC) codes

  • Oncology
  • Gastroenterology
  • Cancer Research


Dive into the research topics of 'Contrasting prognostic effects of tumor-infiltrating lymphocyte density in cardia and non-cardia gastric adenocarcinomas'. Together they form a unique fingerprint.

Cite this