Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan, ROC.
School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist, Taipei City, 112304, Taiwan, ROC.
Thorac Cancer. 2023 May;14(14):1268-1275. doi: 10.1111/1759-7714.14868. Epub 2023 Mar 30.
To investigate whether whole-brain radiotherapy (WBRT) decreases lymphocyte counts and evaluate the impact of treatment-related lymphopenia on survival in patients with brain metastasis.
Medical records from 60 small-cell lung cancer patients treated with WBRT from January 2010 to December 2018 were included in the study. Total lymphocyte count (TLC) was obtained pre and post treatment (within 1 month). We performed linear and logistic regression analyses to identify predictors of lymphopenia. The association between lymphopenia and survival was analyzed using Cox regression analysis.
Thirty-nine patients (65%) developed treatment-related lymphopenia. The median TLC decrease was -374 cells/μL (interquartile range -50 to -722, p < 0.001). Baseline lymphocyte count was a significant predictor of TLC difference and percentage change in TLC. Logistic regression analysis found male sex (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.00-0.79, p = 0.033) and higher baseline lymphocyte count (OR 0.91, 95% CI 0.82-0.99, p = 0.005) were associated with a lower risk of developing ≥grade 2 treatment-related lymphopenia. Cox regression analysis showed that age at brain metastasis (hazard ratio [HR] 1.03, 95% CI 1.01-1.05, p = 0.013), ≥grade 2 treatment-related lymphopenia, and percentage change in TLC (per 10%, HR 0.94, 95% CI 0.89-0.99, p = 0.032) were prognostic factors of survival.
WBRT decreases TLC and the magnitude of treatment-related lymphopenia is an independent predictor of survival in small-cell lung cancer patients.
研究全脑放疗（WBRT）是否会降低淋巴细胞计数，并评估治疗相关的淋巴细胞减少对脑转移患者生存的影响。
本研究纳入了 2010 年 1 月至 2018 年 12 月期间接受 WBRT 的 60 例小细胞肺癌患者的病历资料。治疗前后（1 个月内）均获得总淋巴细胞计数（TLC）。我们进行了线性和逻辑回归分析，以确定淋巴细胞减少的预测因素。采用 Cox 回归分析评估淋巴细胞减少与生存的关系。
39 例患者（65%）发生治疗相关的淋巴细胞减少。TLC 中位数下降了-374 个细胞/μL（四分位距-50 至-722，p<0.001）。基线淋巴细胞计数是 TLC 差值和 TLC 百分比变化的显著预测因素。逻辑回归分析发现，男性（比值比 [OR] 0.11，95%置信区间 [CI] 0.00-0.79，p=0.033）和较高的基线淋巴细胞计数（OR 0.91，95%CI 0.82-0.99，p=0.005）与发生≥2 级治疗相关的淋巴细胞减少的风险较低相关。Cox 回归分析显示，脑转移时的年龄（危险比 [HR] 1.03，95%CI 1.01-1.05，p=0.013）、≥2 级治疗相关的淋巴细胞减少和 TLC 的百分比变化（每 10%，HR 0.94，95%CI 0.89-0.99，p=0.032）是生存的预后因素。
WBRT 会降低 TLC，治疗相关的淋巴细胞减少程度是小细胞肺癌患者生存的独立预测因素。
