淋巴细胞减少与接受外照射放射治疗的肝细胞癌患者的大体肿瘤靶区体积和分割剂量有关，并且也预示着总体生存更差。

Lymphopenia Is Associated with Gross Target Volumes and Fractions in Hepatocellular Carcinoma Patients Treated with External Beam Radiation Therapy and Also Indicates Worse Overall Survival.

机构信息

Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.

Department of Radiation Oncology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471000, China.

出版信息

Can J Gastroenterol Hepatol. 2019 Oct 27;2019:9691067. doi: 10.1155/2019/9691067. eCollection 2019.

DOI:10.1155/2019/9691067

PMID:31781521

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6855067/

Abstract

PURPOSE

To investigate whether lymphocyte nadir induced by radiation is associated with survival and explore its underlying risk factors in patients with hepatocellular carcinoma (HCC).

METHODS

Total lymphocyte counts were collected from 184 HCC patients treated by radiotherapy (RT) with complete follow-up. Associations between gross tumor volumes (GTVs) and radiation-associated parameters with lymphocyte nadir were evaluated by Pearson/Spearman correlation analysis and multiple linear regression. Kaplan-Meier analysis, log-rank test, as well as univariate and multivariate Cox regression were performed to assess the relationship between lymphocyte nadir and overall survival (OS).

RESULTS

GTVs and fractions were negatively related with lymphocyte nadir ( < 0.001 and =0.001, respectively). Lymphocyte nadir and Barcelona Clinic Liver Cancer (BCLC) stage were independent prognostic factors predicting OS of HCC patients (all < 0.001). Patients in the GTV ≤55.0 cc and fractions ≤16 groups were stratified by lymphocyte nadir, and the group with the higher lymphocyte counts (LCs) showed longer survival than the group with lower LCs ( < 0.001 and =0.006, respectively). Patient distribution significantly differed among the RT fraction groups according to BCLC stage ( < 0.001). However, stratification of patients in the same BCLC stage by RT fractionation showed that the stereotactic body RT (SBRT) group achieved the best survival. Furthermore, there were significant differences in lymphocyte nadir among patients in the SBRT group.

CONCLUSIONS

A lower lymphocyte nadir during RT was associated with worse survival among HCC patients. Smaller GTVs and fractions reduced the risk of lymphopenia.

摘要

目的

探讨肝癌（HCC）患者放疗后淋巴细胞最低点与生存的关系，并探讨其潜在的危险因素。

方法

对 184 例接受放疗（RT）且随访完整的 HCC 患者的总淋巴细胞计数进行了收集。采用 Pearson/Spearman 相关分析和多元线性回归评估肿瘤体积（GTVs）和与放疗相关参数与淋巴细胞最低点之间的相关性。采用 Kaplan-Meier 分析、对数秩检验、单因素和多因素 Cox 回归评估淋巴细胞最低点与总生存（OS）之间的关系。

结果

GTVs 和分割数与淋巴细胞最低点呈负相关（均<0.001 和=0.001）。淋巴细胞最低点和巴塞罗那临床肝癌（BCLC）分期是预测 HCC 患者 OS 的独立预后因素（均<0.001）。将 GTVs≤55.0 cc 和分割数≤16 的患者按淋巴细胞最低点分层，淋巴细胞计数较高的组生存时间长于淋巴细胞计数较低的组（均<0.001 和=0.006）。根据 BCLC 分期，不同 RT 分割组的患者分布存在显著差异（<0.001）。然而，按 RT 分割将相同 BCLC 分期的患者分层后，立体定向体部放疗（SBRT）组的生存效果最佳。此外，SBRT 组患者的淋巴细胞最低点存在显著差异。