Service d'Oncologie Radiothérapie, Hôpital Tenon, Paris, France.
Methodological and Quality of Life in Oncology Unit, INSERM UMR 1098, University Hospital of Besancon, France.
Int J Radiat Oncol Biol Phys. 2021 Jul 15;110(4):1022-1031. doi: 10.1016/j.ijrobp.2021.01.052. Epub 2021 Feb 3.
Baseline neutrophil count may predict overall survival (OS) in patients with locally advanced pancreatic cancer (LAPC).
The international multicenter randomized LAP07 phase 3 trial has enrolled 442 patients with LAPC. We analyzed the prognostic value of both baseline neutrophilia (neutrophil count >7 g/L) and elevated or increasing neutrophil count as (1) neutrophilia or (2) increased absolute neutrophil count after induction chemotherapy versus baseline for OS, progression-free survival, and local control (LC). A Cox proportional hazard model was used to assess elevated or increasing neutrophil count status by randomly assigned treatment interactions for each endpoint.
Among the 442 patients, 47 patients (11%) with baseline neutrophilia had worse OS (median 8.9 vs 13.3 months; P = .01). After induction chemotherapy, among the 235 patients whose blood counts were available, 90 patients (38%) had elevated or increasing neutrophil count associated with poorer OS in univariate (median 14.4 vs 17.9 months; P = .001) and multivariate analysis (P = .004). Elevated or increasing neutrophil count was also predictive of a decreased benefit of chemoradiation therapy on LC. In 126 patients without elevated or increasing neutrophil count, 1-year LC was 80% in the chemoradiation arm versus 54% in the chemotherapy arm (P < .001; interaction test P = .015).
In this study, baseline neutrophilia and increased absolute neutrophil count were associated with worse OS in this large series of patients with LAPC. In addition, the counts were an independent prognosis factor and a strong predictive LC biomarker for chemoradiation therapy benefit. An assessment of neutrophils counts can help to improve the selection of patients who might benefit from chemoradiation therapy after induction chemotherapy.
基线中性粒细胞计数可能预测局部晚期胰腺癌（LAPC）患者的总生存期（OS）。
国际多中心随机 LAP07 期 3 试验纳入了 442 例 LAPC 患者。我们分析了基线中性粒细胞增多症（中性粒细胞计数>7 g/L）和诱导化疗后升高或增加的中性粒细胞计数（1）作为中性粒细胞增多症，或（2）与基线相比的绝对中性粒细胞计数对 OS、无进展生存期和局部控制（LC）的预后价值。使用 Cox 比例风险模型评估每个终点的随机分配治疗相互作用的升高或增加的中性粒细胞计数状态。
在 442 例患者中，47 例（11%）基线时中性粒细胞增多症患者 OS 较差（中位 8.9 与 13.3 个月；P=.01）。在诱导化疗后，在可获得血液计数的 235 例患者中，90 例（38%）升高或增加的中性粒细胞计数与较差的 OS 相关，在单变量（中位 14.4 与 17.9 个月；P=.001）和多变量分析（P=.004）中。升高或增加的中性粒细胞计数也预测了放化疗对 LC 的获益降低。在没有升高或增加的中性粒细胞计数的 126 例患者中，放化疗组 1 年 LC 为 80%，化疗组为 54%（P<.001；交互检验 P=.015）。
在这项研究中，在这个大型 LAPC 患者系列中，基线中性粒细胞增多症和绝对中性粒细胞计数增加与较差的 OS 相关。此外，这些计数是独立的预后因素，也是放化疗获益的强烈预测 LC 生物标志物。评估中性粒细胞计数有助于改善选择可能从诱导化疗后放化疗获益的患者。
