CD66b + neutrophils and α-SMA + fibroblasts predict clinical outcomes and benefits from postoperative chemotherapy in gastric adenocarcinoma.

Background Emerging evidence indicates that the tumor microenvironment (TME) influences tumor progression through the various cells it contains. Tumor-associated neutrophils (TANs) and cancer-associated fibroblasts (CAFs) are prominent constituents of diverse malignant solid tumors and are crucial in the TME and cancer evolution. However, the relationships and combined prognostic value of these two cell types are not known in gastric adenocarcinoma (GAC). Materials and Methods In total, 215 GAC patients who underwent curative surgery were enrolled. TANs were assessed by immunohistochemical staining for CD66b, and CAFs were evaluated by immunohistochemical staining for alpha-smooth muscle actin (alpha-SMA). Results The percentages of patients with high-density TANs and CAFs in GAC tissue were 47.9% (103/215) and 43.3% (93/215), respectively. The densities of TANs and CAFs in GAC tissue samples were markedly elevated and independently correlated with GAC clinical outcomes. A strong correlation (R = .348, P < .001) was detected between TANs and CAFs in GAC. The combination of TANs and CAFs produced a more exact outcome than either factor alone. Patients with an alpha-SMA(low)CD66b(high) (hazard ratio [HR] = 1.791; 95% CI: 1.062-3.021; P = .029), alpha-SMA(high)CD66b(low) (HR = 2.402; 95% CI: 1.379-4.183; P = .002), or alpha-SMA(high)CD66b(high) (HR = 3.599; 95% CI: 2.330-5.560; P < .001) phenotype were gradually correlated with poorer disease-free survival than the subset of patients with an alpha-SMA(low)CD66b(low) phenotype. The same results were observed for disease-specific survival in the subgroups. Noticeably, in stage II-III patients with the alpha-SMA(low)CD66b(low) phenotype, an advantage was obtained with postoperative chemotherapeutics, and the risk of a poor prognosis was reduced compared with stage II-III patients with the alpha-SMA(low)CD66b(high), alpha-SMA(high)CD66b(low) or alpha-SMA(high)CD66b(high) phenotype (HR: 0.260, 95% CI: 0.124-0.542, P < .001 for disease-free survival; and HR: 0.258, 95% CI: 124-0.538, P < .001 for disease-specific survival). Conclusion Overall, we concluded that the combination of CD66b(+) TANs and alpha-SMA(+) CAFs could be used as an independent factor for patient outcomes and to identify GAC patients who might benefit from the administration of postoperative chemotherapeutics.