Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.
Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China.
Head Neck. 2022 Jan;44(1):34-45. doi: 10.1002/hed.26897. Epub 2021 Oct 12.
To evaluate the prognostic value of the dynamic change in absolute lymphocyte counts (ALCs) and absolute monocyte counts (AMCs) and identify patients with N stage and plasma Epstein-Barr virus (EBV) DNA levels in nasopharyngeal carcinoma (NPC) who are at risk of treatment failure.
A total of 1124 eligible patients with Stage II-IVb NPC treated with concurrent chemoradiotherapy (CCRT) were enrolled. Percentage changes in the ALC (ΔALC%) and AMC (ΔAMC%) were calculated.
Patients with high ΔALC% were correlated with poorer 5-year overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) rates than those with low ΔALC%. Likewise, high ΔAMC% was significantly associated with worse outcome than low ΔAMC% (OS, p = 0.001; PFS, p = 0.001; DMFS, p = 0.034). Multivariate analyses revealed that ΔALC% (p = 0.046), ΔAMC% (p = 0.019), and EBV DNA level (p < 0.001) were independent prognostic factors for OS. With respect to PFS, ΔALC% (p = 0.036), ΔAMC% (p = 0.011), N classification (p = 0.016), and EBV DNA level (p < 0.001) were also independent prognosticators. Based on the aforementioned independent risk factors (ΔALC% ≥ 83.33%, ΔAMC% ≥ 40.00%, Stage N2-3, EBV DNA ≥ 4000 copies/ml), patients were divided into three different risk groups (low-risk group [with <1 risk factor], intermediate risk group [with 1-3 risk factors], and high-risk group [with 4 risk factors]) that correlated with disparate risks of death (p < 0.001), disease progression (p < 0.001), and distant metastasis (p < 0.001).
High ΔALC% and ΔAMC% were correlated with poor prognosis in patients with NPC. Risk stratification based on ΔALC%, ΔAMC%, N classification, and plasma EBV DNA levels could provide potential utility for risk-adapted therapeutic strategies for NPC.
评估绝对淋巴细胞计数（ALC）和绝对单核细胞计数（AMC）动态变化的预后价值，并确定具有 N 期和血浆 Epstein-Barr 病毒（EBV）DNA 水平的鼻咽癌（NPC）患者有治疗失败的风险。
共纳入 1124 例接受同期放化疗（CCRT）治疗的 II-IVb 期 NPC 患者。计算 ALC（ΔALC%）和 AMC（ΔAMC%）的百分比变化。
与低ΔALC%患者相比，高ΔALC%患者的 5 年总生存率（OS）、无进展生存率（PFS）和无远处转移生存率（DMFS）更差。同样，高ΔAMC%与较差的结局显著相关，与低ΔAMC%相比（OS，p=0.001；PFS，p=0.001；DMFS，p=0.034）。多变量分析显示，ΔALC%（p=0.046）、ΔAMC%（p=0.019）和 EBV DNA 水平（p<0.001）是 OS 的独立预后因素。关于 PFS，ΔALC%（p=0.036）、ΔAMC%（p=0.011）、N 分类（p=0.016）和 EBV DNA 水平（p<0.001）也是独立的预后因素。基于上述独立的危险因素（ΔALC%≥83.33%，ΔAMC%≥40.00%，N 期 N2-3，EBV DNA≥4000 拷贝/ml），患者被分为三个不同的风险组（低危组[<1 个危险因素]，中危组[1-3 个危险因素]和高危组[4 个危险因素]），与死亡风险（p<0.001）、疾病进展（p<0.001）和远处转移（p<0.001）显著相关。
高ΔALC%和ΔAMC%与 NPC 患者的不良预后相关。基于ΔALC%、ΔAMC%、N 分类和血浆 EBV DNA 水平的风险分层可为 NPC 的风险适应治疗策略提供潜在的应用价值。
