Kang Byung-Hee, Li Xue, Son Jaeman, Song Changhoon, Kang Hyun-Cheol, Kim Hak Jae, Wu Hong-Gyun, Lee Joo Ho
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.
Front Oncol. 2022 Aug 18;12:891221. doi: 10.3389/fonc.2022.891221. eCollection 2022.
The dosimetric factors of radiotherapy have an acute impact on the host immune system during chemoradiotherapy (CRT) in locally advanced non-small cell lung cancer (NSCLC). However, even after CRT, a substantial number of patients remain immunosuppressed with delayed lymphopenia. Therefore, we aimed to evaluate clinical and dose-volumetric predictors of delayed lymphopenia after CRT in locally advanced NSCLC.
We retrospectively reviewed 272 patients with locally advanced NSCLC who received definitive CRT from January 2012 to August 2020. Differential blood count data, including serum albumin values, were obtained at baseline, during and at first follow up after CRT. Acute and delayed lymphopenia events were defined as grade III/IV lymphopenia developed during or 4-12 weeks after CRT completion, which accounted for 84% and 10% of cases, respectively. Dose-volume histogram parameters for planned target volume, whole body, heart, lung, great vessels, spleen, esophagus and thoracic vertebral bodies were evaluated.
Multivariate analysis revealed that patients with delayed lymphopenia were associated with inferior overall survival (HR 2.53, = 0.001) and progression-free survival (HR 1.98, = 0.006). However, there was no significant survival difference between groups stratified by acute lymphopenia. On multivariable logistic regression models, lung V5, baseline ALC, during-CRT ALC, and albumin nadir were significant predictors for delayed lymphopenia. Furthermore, the nomogram for delayed lymphopenia based on these variables had good discrimination (area under the curve, 0.905).
In this study, we investigated the prognostic significance of delayed lymphopenia and identified clinico-dosimetric parameters to predict delayed lymphopenia.
在局部晚期非小细胞肺癌（NSCLC）的放化疗（CRT）期间，放疗的剂量学因素对宿主免疫系统有急性影响。然而，即使在CRT之后，仍有相当数量的患者存在免疫抑制并伴有延迟性淋巴细胞减少。因此，我们旨在评估局部晚期NSCLC患者CRT后延迟性淋巴细胞减少的临床和剂量体积预测因素。
我们回顾性分析了2012年1月至2020年8月期间接受根治性CRT的272例局部晚期NSCLC患者。在基线、CRT期间及首次随访时获取包括血清白蛋白值在内的血常规数据。急性和延迟性淋巴细胞减少事件分别定义为CRT完成期间或之后4 - 12周出现的III/IV级淋巴细胞减少，分别占病例的84%和10%。评估计划靶体积、全身、心脏、肺、大血管、脾脏、食管和胸椎椎体的剂量体积直方图参数。
多因素分析显示，延迟性淋巴细胞减少的患者总生存期较差（HR 2.53， = 0.001），无进展生存期也较差（HR 1.98， = 0.006）。然而，按急性淋巴细胞减少分层的组间生存无显著差异。在多变量逻辑回归模型中，肺V5、基线绝对淋巴细胞计数（ALC）、CRT期间ALC和白蛋白最低点是延迟性淋巴细胞减少的显著预测因素。此外，基于这些变量的延迟性淋巴细胞减少列线图具有良好的区分度（曲线下面积，0.905）。
在本研究中，我们调查了延迟性淋巴细胞减少的预后意义，并确定了预测延迟性淋巴细胞减少的临床剂量学参数。
