Chen Meng, Chen Kuifei, Li Shuling, Meng Yinnan, Shi Yangyang, Chen Xiaofeng, Yang Haihua
School of Medicine, Shaoxing University, Shaoxing, China.
Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou, China.
J Thorac Dis. 2022 Feb;14(2):494-506. doi: 10.21037/jtd-22-130.
Clinically, there is a lack of simple and feasible indicators to predict the efficacy of stereotactic body radiation therapy (SBRT). Circulating lymphocyte counts (CLCs) is considered to be related to curative effect in conventional radiotherapy of lung cancer, and blood groups are also associated with the survival. In this study, we investigate the prognostic value of CLCs and ABO blood groups in lung cancer patients treated with SBRT.
We retrospectively analyzed 191 patients who were treated with lung cancer SBRT in Taizhou Hospital of Zhejiang Province from September 2014 to December 2018. The medical record system of Taizhou Hospital was used to collect relevant clinical data, such as stage, CLC, ABO blood groups and other important clinical co-variates. The effects of SBRT were evaluated by patient reexamination image data and telephone follow-up. The RECIST 1.1 standard was used to evaluate the short-term efficacy in the first, third, and sixth months after SBRT. Progression-free survival (PFS) was defined as the time from the day of SBRT to disease progression or death from any cause. Overall survival (OS) was measured from the day of SBRT until the last follow-up or death. Survival curves and univariate, multivariate logistic-regression analyses were used to expound the prognostic factors for local control (LC), PFS, and OS of lung cancer SBRT patients.
Univariate and multivariate analysis results showed that post-SBRT CLCs were independent factors for the short-term efficacy 3 and 6 months after lung cancer SBRT [hazard ratio (HR) =0.249, P=0.037; HR =0.347, P=0.012]. Survival analyses showed that the PFS and OS of lung cancer SBRT patients with A blood type was significantly shorter than that in the other three non-A blood groups (PFS: 6.5 10 months, HR =1.535, P=0.020; OS: 24 41 months, HR =1.578, P=0.048). Moreover, the patients with high post-SBRT CLCs in the non-A blood group had the longest PFS and OS after lung cancer SBRT (HR =0.551, P=0.043).
Lung cancer SBRT patients with high-post-SBRT CLCs and non-A blood groups seem to exhibits best curative effect, which represent a potential opportunity to improve the clinical management of these patients. The mechanisms of this association deserve further verification and investigation.
临床上，缺乏简单可行的指标来预测立体定向体部放疗（SBRT）的疗效。循环淋巴细胞计数（CLCs）被认为与肺癌传统放疗的疗效相关，并且血型也与生存率有关。在本研究中，我们调查了CLCs和ABO血型在接受SBRT治疗的肺癌患者中的预后价值。
我们回顾性分析了2014年9月至2018年12月在浙江省台州医院接受肺癌SBRT治疗的191例患者。利用台州医院的病历系统收集相关临床数据，如分期、CLCs、ABO血型和其他重要的临床协变量。通过患者复查影像数据和电话随访评估SBRT的疗效。采用RECIST 1.1标准评估SBRT后第1、3和6个月的短期疗效。无进展生存期（PFS）定义为从SBRT之日到疾病进展或因任何原因死亡的时间。总生存期（OS）从SBRT之日开始测量，直至最后一次随访或死亡。采用生存曲线以及单因素、多因素逻辑回归分析来阐述肺癌SBRT患者局部控制（LC）、PFS和OS的预后因素。
单因素和多因素分析结果显示，SBRT后CLCs是肺癌SBRT后3个月和6个月短期疗效的独立因素[风险比（HR）=0.249，P=0.037；HR =0.347，P=0.012]。生存分析表明，A型血的肺癌SBRT患者的PFS和OS显著短于其他三种非A型血患者（PFS：6.5 10个月，HR =1.535，P=0.020；OS：24 41个月，HR =1.578，P=0.048）。此外，非A型血中SBRT后CLCs高的患者在肺癌SBRT后的PFS和OS最长（HR =0.551，P=0.043）。
SBRT后CLCs高且为非A型血的肺癌患者似乎表现出最佳疗效，这为改善这些患者的临床管理提供了一个潜在机会。这种关联的机制值得进一步验证和研究。
