Department of Radiation Oncology, Cancer Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No. 158, Shangtang Road, Xiacheng District, Hangzhou, 310014, China.
Department of Radiation Oncology, Taizhou Cancer Hospital, Taizhou, 317502, China.
World J Surg Oncol. 2019 Nov 30;17(1):199. doi: 10.1186/s12957-019-1747-9.
Colorectal cancer is the fourth most common cancer globally and neoadjuvant concurrent chemoradiotherapy (nCRT) and surgery are the standard treatments for locally advanced colorectal carcinoma. This study investigated the association between dynamic changes in absolute lymphocyte counts (ALCs) and disease-free survival (DFS) in rectal cancer patients receiving nCRT and identified factors associated with these changes.
We retrospectively examined 34 patients with locally advanced rectal cancer who received nCRT followed by surgery and adjuvant chemotherapy. The association between ALCs and DFS and that between ALCs and downstaging were analyzed and potential clinical- and treatment-related factors related to dynamic changes in ALCs were subsequently evaluated. The patient eligibility criteria were as follows: pathologically confirmed rectal adenocarcinoma, clinical stages II-III, ≥ 18 years of age, and so on. Pre-RTL was defined as ALCs obtained before the initiation of nCRT and pre-SL was defined as ALCs obtained before surgery. We measured pre-SL to pre-RTL ratio (pre-SLR), DFS, and ALCs.
The median ALC declined significantly during nCRT. A lower pre-SLR was associated with poorer DFS with statistical significance in Kaplan-Meier (p = 0.007), univariate regression (hazard ratio [HR] = 6.287, 95% confidence interval [CI] 1.374-28.781, p = 0.018), and multivariable regression (HR = 7.347, 95% CI 1.595-33.850, p = 0.011) analyses. Neither patient characteristics nor treatment-related factors were related to downstaging. The pelvic bone marrow (PBM) volume receiving at least 30 Gy (V30) was significantly associated with pre-SLR in the univariate (HR = 5.760, 95% CI 1.317-25.187, p = 0.020) and multivariable (HR = 5.760, 95% CI 1.317-25.187, p = 0.020) regression analyses.
Our study had several limitations. The sample size was small and the study was performed in a selected population, which may limit the generalization of the findings.
Radiotherapy had a profound impact on the change in ALCs. A lower pre-SLR was significantly associated with poorer DFS in rectal cancer patients receiving nCRT. The V30 of PBM was a predictor of pre-SLR.
结直肠癌是全球第四大常见癌症，新辅助同期放化疗（nCRT）加手术是局部晚期结直肠癌的标准治疗方法。本研究旨在探讨直肠癌患者接受 nCRT 后绝对淋巴细胞计数（ALC）的动态变化与无病生存（DFS）之间的关系，并确定与这些变化相关的因素。
我们回顾性分析了 34 例接受 nCRT 后行手术和辅助化疗的局部晚期直肠癌患者。分析了 ALC 与 DFS 之间的关系，以及 ALC 与降期之间的关系，并随后评估了与 ALC 动态变化相关的潜在临床和治疗相关因素。患者入选标准如下：经病理证实为直肠腺癌、临床分期 II-III 期、年龄≥18 岁等。Pre-RTL 定义为 nCRT 前获得的 ALC，Pre-SL 定义为手术前获得的 ALC。我们测量了 Pre-SL 与 Pre-RTL 的比值（Pre-SLR）、DFS 和 ALC。
nCRT 期间，ALC 中位数明显下降。Kaplan-Meier 分析（p=0.007）、单因素回归（风险比[HR] = 6.287，95%置信区间[CI] 1.374-28.781，p=0.018）和多因素回归（HR = 7.347，95%CI 1.595-33.850，p=0.011）分析显示，较低的 Pre-SLR 与较差的 DFS 显著相关。患者特征和治疗相关因素均与降期无关。骨盆骨髓（PBM）接受至少 30Gy（V30）的体积与单因素（HR = 5.760，95%CI 1.317-25.187，p=0.020）和多因素（HR = 5.760，95%CI 1.317-25.187，p=0.020）回归分析中的 Pre-SLR 显著相关。
本研究存在一些局限性。样本量较小，且研究在选定人群中进行，这可能限制了研究结果的推广。
放疗对 ALC 变化有显著影响。直肠癌患者接受 nCRT 后，较低的 Pre-SLR 与较差的 DFS 显著相关。PBM 的 V30 是 Pre-SLR 的预测因子。
