State Key Laboratory of Oncology in South People's Republic of China Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, People's Republic of China.
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
Oncologist. 2023 Aug 3;28(8):e606-e616. doi: 10.1093/oncolo/oyad094.
To investigate the association between absolute lymphocyte count (ALC) nadir and survival outcomes in esophageal squamous cell carcinoma (ESCC) patients who received definitive chemoradiotherapy (CRT) combined with anti-PD-1 immunotherapy, as well as to explore clinical characteristics and dosimetric parameters that affect ALC nadir during CRT.
Patients with ESCC (n = 602) who underwent definitive CRT were analyzed, of whom 166 received combined anti-PD-1 immunotherapy and CRT. Changes in ALC and survival were compared between patients with and without immunotherapy. Propensity score matching (PSM) was performed to minimize the effects of confounding factors. Low ALC was defined as nadir of <0.33 × 103 cells/μL during CRT (top tertile). Univariate and multivariate logistic regression were used to identify predictors of low ALC nadir.
Patients with immunotherapy had significantly higher ALC in the first 3 weeks during CRT and higher ALC nadir than those without. Overall survival was more favorable in patients with immunotherapy both before and after PSM. After a median follow-up of 12.1 months, patients with low ALC during CRT had a worse progression-free survival (PFS) (P = .026). In multivariate analysis, low ALC remained a significant prognostic factor for PFS. Planning target volume (PTV) and heart V5 were revealed to be independent predictors of low ALC.
The addition of anti-PD-1 immunotherapy to definitive CRT could mitigate the decline of ALC during radiotherapy and might prolong survival. Low ALC nadir was correlated to worse PFS, larger PTV, and higher heart V5 in patients receiving combined immunotherapy and CRT.
为了研究接受根治性放化疗（CRT）联合抗 PD-1 免疫治疗的食管鳞癌（ESCC）患者绝对淋巴细胞计数（ALC）最低值与生存结局的相关性，以及探讨影响 CRT 期间 ALC 最低值的临床特征和剂量学参数。
分析了 602 例接受根治性 CRT 的 ESCC 患者，其中 166 例接受了联合抗 PD-1 免疫治疗和 CRT。比较了免疫治疗组和无免疫治疗组患者的 ALC 变化和生存情况。采用倾向评分匹配（PSM）最小化混杂因素的影响。低 ALC 定义为 CRT 期间（最高三分位）<0.33×103 个细胞/μL 的最低值。采用单因素和多因素 logistic 回归分析确定低 ALC 最低值的预测因素。
免疫治疗组患者在 CRT 的前 3 周内 ALC 显著升高，且 ALC 最低值高于无免疫治疗组。在 PSM 前后，免疫治疗组患者的总生存期均更有利。中位随访 12.1 个月后，CRT 期间低 ALC 的患者无进展生存期（PFS）更差（P=0.026）。多因素分析显示，低 ALC 仍然是 PFS 的显著预后因素。计划靶区（PTV）和心脏 V5 被揭示为低 ALC 的独立预测因素。
抗 PD-1 免疫治疗联合根治性 CRT 可减轻放疗期间 ALC 的下降，并可能延长生存时间。接受联合免疫治疗和 CRT 的患者，低 ALC 最低值与更差的 PFS、更大的 PTV 和更高的心脏 V5 相关。
