Jing Wang, Liu Yufei, Zhu Hui, Welsh James, Gandhi Saumil, Jeter Melenda, Nguyen Quynh, Chen Aileen B, O'Reilly Michael, Liao Zhongxing, Chang Joe Y, Lee Percy, Lin Steven H
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Shandong, China.
Clin Transl Radiat Oncol. 2021 Mar 12;28:54-61. doi: 10.1016/j.ctro.2021.02.011. eCollection 2021 May.
To investigate the incidence and prognosis of severe radiation-induced lymphopenia (sRIL) after postoperative radiotherapy (PORT) for resected NSCLC.
Between 1998 and 2017, 170 patients treated with PORT for NSCLC were retrospectively reviewed. Lymphopenia was divided into tertiles with severe lymphopenia defined as absolute lymphocyte counts (ALC) < 0.37 × 10/ul.
sRIL was observed in 32.3% of patients. Multivariable logistic regression analysis indicated sRIL was associated with planning target volume radiation fraction numbers (OR 1.09, = 0.005) and total lung mean dose (OR 1.12, = 0.006). With a median follow-up time of 12.2 years, the median progression-free survival and overall survival were 14.8 months and 28.4 months respectively in patients with sRIL, vs. 21.7 months ( = 0.008) and 48.3 months ( = 0.01) respectively in patients without sRIL. Multivariable analyses indicated sRIL significantly decreased OS (HR 1.95, < 0.01). Since PORT for stage I-II NSCLC was done largely for positive margins, which may confound the contribution of severe RIL, we analyzed stage III separately and found that sRIL also significantly decreased OS (HR 1.88, = 0.004) in multivariable analysis.
For this long-term outcome study, severe RIL correlated with total lung mean dose and radiation fractionation numbers, and was a strong prognostic factor for poor survival in PORT patients, particularly in patients with stage III NSCLC, highlighting the importance of an intact immune system for post-radiation immunologic disease surveillance.
探讨手术切除的非小细胞肺癌（NSCLC）术后放疗（PORT）后严重放射性淋巴细胞减少症（sRIL）的发生率及预后。
回顾性分析1998年至2017年间170例行PORT治疗的NSCLC患者。淋巴细胞减少症分为三个等级，严重淋巴细胞减少定义为绝对淋巴细胞计数（ALC）<0.37×10⁹/μl。
32.3%的患者出现sRIL。多变量逻辑回归分析表明，sRIL与计划靶体积放疗分次次数（比值比[OR]1.09，P = 0.005）和全肺平均剂量（OR 1.12，P = 0.006）相关。中位随访时间为12.2年，sRIL患者的中位无进展生存期和总生存期分别为14.8个月和28.4个月，而无sRIL患者分别为21.7个月（P = 0.008）和48.3个月（P = 0.01）。多变量分析表明，sRIL显著降低总生存期（风险比[HR]1.95，P<0.01）。由于I-II期NSCLC的PORT主要是针对切缘阳性进行的，这可能混淆严重放射性淋巴细胞减少症的影响，我们单独分析了III期患者，发现多变量分析中sRIL也显著降低总生存期（HR 1.88，P = 0.004）。
在这项长期结局研究中，严重放射性淋巴细胞减少症与全肺平均剂量和放疗分次次数相关，是PORT患者生存不良的一个强有力的预后因素，尤其是III期NSCLC患者，突出了完整免疫系统对放疗后免疫疾病监测的重要性。
