Department of Radiation Oncology, Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Sun Yat-sen University, Guangzhou, China.
Department of Pathology, Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Sun Yat-sen University, Guangzhou, China.
Ann Surg Oncol. 2019 Sep;26(9):2882-2889. doi: 10.1245/s10434-019-07334-7. Epub 2019 Apr 29.
To investigate the relationship between treatment-related lymphopenia and pathologic response to neoadjuvant chemoradiotherapy (CRT) in patients with esophageal squamous cell carcinoma (ESCC).
Between 2002 and 2016, 220 ESCC patients treated with neoadjuvant CRT followed by surgery were retrospectively analyzed. Absolute lymphocyte count was determined before, during, and 1 month after neoadjuvant CRT. Treatment-related lymphopenia was graded using Common Terminology Criteria for Adverse Events version 4.0. Relationship between lymphopenia with pathologic complete response (pCR) and recurrence were evaluated.
Ninety-five patients (43.2%) achieved a pCR after neoadjuvant CRT and 71 patients (32.3%) developed recurrences. The incidence of grade 0, 1, 2, 3, and 4 lymphopenia during CRT were 1.8%, 6.8%, 31.4%, 38.2% and 21.8%, respectively. Patients with grade 4 lymphopenia had a significantly lower pCR rate than those with grade 0-3 lymphopenia (22.9% vs. 48.8%, P = 0.001). Moreover, grade 4 lymphopenia was significantly associated with a higher risk of recurrences (45.8% vs. 28.5%, P = 0.023). Multivariable analysis identified that primary tumor length, tumor location, and radiation dose were independent predictors for grade 4 lymphopenia.
ESCC patients with grade 4 lymphopenia during neoadjuvant CRT were associated with a significantly lower pCR rate and a higher recurrence risk.
研究食管鳞癌（ESCC）患者新辅助放化疗（CRT）相关的淋巴细胞减少与病理反应之间的关系。
回顾性分析了 2002 年至 2016 年间 220 例接受新辅助 CRT 联合手术治疗的 ESCC 患者。在新辅助 CRT 前、期间和 1 个月后测定绝对淋巴细胞计数。使用不良事件通用术语标准 4.0 对治疗相关的淋巴细胞减少进行分级。评估淋巴细胞减少与病理完全缓解（pCR）和复发之间的关系。
95 例（43.2%）患者在新辅助 CRT 后获得了 pCR，71 例（32.3%）患者出现了复发。CRT 期间发生 0 级、1 级、2 级、3 级和 4 级淋巴细胞减少的发生率分别为 1.8%、6.8%、31.4%、38.2%和 21.8%。发生 4 级淋巴细胞减少的患者 pCR 率明显低于 0-3 级淋巴细胞减少的患者（22.9% vs. 48.8%，P=0.001）。此外，4 级淋巴细胞减少与复发风险显著相关（45.8% vs. 28.5%，P=0.023）。多变量分析确定原发肿瘤长度、肿瘤位置和放疗剂量是 4 级淋巴细胞减少的独立预测因素。
新辅助 CRT 期间发生 4 级淋巴细胞减少的 ESCC 患者，pCR 率明显较低，复发风险较高。
