Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States; Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, China.
Radiother Oncol. 2019 Apr;133:9-15. doi: 10.1016/j.radonc.2018.12.002. Epub 2019 Jan 11.
Radiation-induced lymphopenia (RIL) during therapy is associated with poor prognosis but is often temporary and resolves after treatment completion in esophageal cancer. How lymphocyte recovery contributes to prognosis is unknown.
We reviewed 755 patients with stage I-III esophageal carcinoma who received concurrent chemoradiation therapy (CRT) with or without surgery in 2004-2015. Complete blood counts were obtained before, during, and at first follow-up after CRT. Lymphopenia was graded per the Common Terminology Criteria for Adverse Events v4.03 during CRT (G) and as recovery after CRT (G). Clinical factors and lymphopenia grade were tested for association with survival in univariable and multivariable Cox proportional hazard regression analyses.
During CRT, 294 patients (38.9%) had G4 lymphopenia; by the first follow-up, 406 patients (53.8%) had recovered (G0-1). Relative to patients with G0-3 lymphopenia during CRT, G4 lymphopenia independently predicted worse OS in multivariable analyses. However, lymphocyte recovery was not associated with a better prognosis. Patients with G4 lymphopenia during CRT and recovery (G0-1) afterward still had poorer 5-year OS rate than patients with G0-3 during CRT without recovery (G2-4) afterward (36.6% vs. 51.9%, HR = 1.40, 95% CI 1.04-1.89, P = 0.027). Moreover, the lymphocyte recovery ability (post-CRT ALC divided by pre-CRT ALC) was not affected by lymphopenia grade during CRT (0.66 in G0-3 vs. 0.65 in G4, p = 0.473). Among patients with G4 lymphopenia during treatment, lymphocyte recovery was only associated with pre-CRT lymphocyte counts.
Lymphocyte count recovery after CRT does not alter the poor long-term outcomes brought about by high-grade lymphopenia during CRT.
治疗期间的辐射诱导性淋巴细胞减少症（RIL）与预后不良相关，但通常是暂时的，并在食管癌治疗完成后恢复。淋巴细胞恢复如何影响预后尚不清楚。
我们回顾了 2004 年至 2015 年间接受同期放化疗（CRT）加或不加手术的 I-III 期食管癌患者 755 例。在 CRT 前后和 CRT 后首次随访时获得全血细胞计数。根据通用不良事件术语标准 4.03（G）在 CRT 期间和 CRT 后恢复时（G）对淋巴细胞减少症进行分级。在单变量和多变量 Cox 比例风险回归分析中，检验临床因素和淋巴细胞减少症分级与生存的相关性。
在 CRT 期间，294 例患者（38.9%）发生 G4 淋巴细胞减少症；在首次随访时，406 例患者（53.8%）已恢复（G0-1）。与 CRT 期间发生 G0-3 淋巴细胞减少症的患者相比，G4 淋巴细胞减少症在多变量分析中独立预测 OS 更差。然而，淋巴细胞恢复与预后无相关性。在 CRT 期间发生 G4 淋巴细胞减少症并在随后恢复（G0-1）的患者，其 5 年 OS 率仍低于 CRT 期间未恢复（G2-4）的患者（36.6%比 51.9%，HR=1.40，95%CI 1.04-1.89，P=0.027）。此外，淋巴细胞恢复能力（CRT 后 ALC 除以 CRT 前 ALC）不受 CRT 期间淋巴细胞减少症分级的影响（G0-3 为 0.66，G4 为 0.65，P=0.473）。在治疗期间发生 G4 淋巴细胞减少症的患者中，淋巴细胞恢复仅与 CRT 前淋巴细胞计数相关。
CRT 后淋巴细胞计数的恢复并不能改变 CRT 期间发生高等级淋巴细胞减少症带来的不良长期预后。
