Wang Xin, Zhao Zongxing, Wang Peiliang, Geng Xiaotao, Zhu Liqiong, Li Minghuan
Department of Clinical Medicine, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Front Oncol. 2020 Jun 23;10:997. doi: 10.3389/fonc.2020.00997. eCollection 2020.
Lymphocytes are central players in systemic anti-tumor immune responses. In this study, we aimed to identify the relationship between absolute lymphocyte count (ALC) nadir during definitive radiotherapy (RT) and survival outcomes in patients with esophageal squamous cell carcinoma (ESCC), as well as evaluate the effect of RT parameters on ALC during RT. We retrospectively reviewed 189 patients with stage I-IVA ESCC, who were treated with definitive RT at a single institution between 2012 and 2015. ALC values were assessed before, weekly during RT, and 1 month after the end of RT. Kaplan-Meier and Cox regression analyses were used to evaluate the relationship between ALC nadir during RT and patient outcomes. Predictors of low ALC nadir were assessed using univariate and multivariate logistic regression analyses. The median ALC before treatment was 1.73 × 10 cells/μL. Fifty-eight (58.2) percent of the patients exhibited low ALC nadir (≤ 0.38 × 10 cells/μL) during RT. A low ALC nadir during RT was significantly associated with poor OS, PFS, and LRFS. The planning target volume (PTV) was larger in patients with low ALC nadir compared with patients with high ALC nadir (418.5 vs. 347.7 cm, = 0.023). Multivariate logistic regression analysis revealed that tumor stage III-IVA ( = 0.002), low ALC before treatment ( = 0.028), large Log(PTV) ( = 0.01), high heart V10 ( = 0.003), and high heart V20 ( = 0.028) were associated with low ALC nadir during RT. In ESCC patients who received definitive RT, a low ALC nadir during RT was associated with large PTVs, and it was an independent prognostic factor of outcomes.
淋巴细胞是全身抗肿瘤免疫反应的核心参与者。在本研究中，我们旨在确定食管鳞状细胞癌（ESCC）患者在根治性放疗（RT）期间的淋巴细胞绝对计数（ALC）最低点与生存结果之间的关系，并评估放疗参数对放疗期间ALC的影响。我们回顾性分析了2012年至2015年在单一机构接受根治性放疗的189例I-IVA期ESCC患者。在放疗前、放疗期间每周以及放疗结束后1个月评估ALC值。采用Kaplan-Meier法和Cox回归分析评估放疗期间ALC最低点与患者预后的关系。使用单因素和多因素逻辑回归分析评估低ALC最低点的预测因素。治疗前ALC的中位数为1.73×10⁹细胞/μL。58例（58.2%）患者在放疗期间出现低ALC最低点（≤0.38×10⁹细胞/μL）。放疗期间低ALC最低点与较差的总生存期（OS）、无进展生存期（PFS）和局部区域无复发生存期（LRFS）显著相关。与高ALC最低点的患者相比，低ALC最低点的患者计划靶体积（PTV）更大（418.5 vs. 347.7 cm³，P = 0.023）。多因素逻辑回归分析显示，肿瘤III-IVA期（P = 0.002）、治疗前低ALC（P = 0.028）、大的Log(PTV)（P = 0.01）、高心脏V10（P = 0.003）和高心脏V20（P = 0.028）与放疗期间低ALC最低点相关。在接受根治性放疗的ESCC患者中，放疗期间低ALC最低点与大PTV相关，并且是预后的独立预测因素。
