Ni Wenjie, Wang Xiunan, Wang Qin, Ge Yongqing, Mu Xiaofeng
Department of Radiation Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China.
Cancer Manag Res. 2025 May 28;17:1047-1058. doi: 10.2147/CMAR.S522807. eCollection 2025.
To investigate the effects of radiation-induced lymphopenia (RIL) on survival in postmastectomy radiotherapy (RT) patients and identify relevant RIL predictive factors.
Patients with breast cancer who received postmastectomy radiotherapy at the study hospital were enrolled over June 2016 to December 2022. The peripheral blood counts were obtained before and during treatment and at the first posttreatment follow-up. Lymphopenia was graded according to the degree of lymphocyte reduction. The Kaplan-Meier method was used to compare disease-free survival (DFS) and overall survival (OS) between grade 0-2 (G0-2) and grade 3 (G3) lymphopenia, and the Log rank test was used to compare between-group differences. DFS prognostic factors were determined through Cox regression analysis, and G3 lymphopenia predictive factors were assessed through logistic regression analysis.
156 patients with a median RT duration of 5.0 weeks were enrolled. During treatment, 29 (18.6%), 36 (23.1%), 67 (42.9%), and 24 (15.4%) patients had G0, G1, G2, and G3 lymphopenia, respectively. Over RT duration, the absolute lymphocyte counts continued to decrease until they reached the nadir at week 5. The median follow-up duration was 45.5 months. The 1, 3-, and 5-year DFS rates were 97.0%, 90.3%, and 87.4% in the G0-2 group, respectively; they were higher than those in the G3 group (83.3%, 69.2%, and 39.5%, respectively; < 0.001). Cox univariate and multivariate analyses revealed that pathological stage and lymphopenia degree were independent prognostic factors for DFS (both < 0.001). Logistic regression analysis revealed that low body mass index (BMI), integrated RT, and high heart (D ≥ 6 Gy) and sternum (D ≥ 20Gy) exposure dose were associated with G3 lymphopenia (all < 0.05).
G3 RIL led to poor DFS in postmastectomy radiotherapy patients. BMI, RT modality, and heart and sternum exposure dose were noted to be independent RIL risk factors.
探讨放疗诱导的淋巴细胞减少症（RIL）对乳房切除术后放疗（RT）患者生存的影响，并确定相关的RIL预测因素。
纳入2016年6月至2022年12月在研究医院接受乳房切除术后放疗的乳腺癌患者。在治疗前、治疗期间及首次治疗后随访时获取外周血细胞计数。根据淋巴细胞减少程度对淋巴细胞减少症进行分级。采用Kaplan-Meier法比较0-2级（G0-2）和3级（G3）淋巴细胞减少症患者的无病生存期（DFS）和总生存期（OS），采用Log rank检验比较组间差异。通过Cox回归分析确定DFS的预后因素，通过逻辑回归分析评估G3淋巴细胞减少症的预测因素。
共纳入156例患者，中位放疗时间为5.0周。治疗期间，分别有29例（18.6%）、36例（23.1%）、67例（42.9%）和24例（15.4%）患者出现G0、G1、G2和G3淋巴细胞减少症。在放疗期间，绝对淋巴细胞计数持续下降，直至第5周达到最低点。中位随访时间为45.5个月。G0-2组的1年、3年和5年DFS率分别为97.0%、90.3%和87.4%；高于G3组（分别为83.3%、69.2%和39.5%；<0.001）。Cox单因素和多因素分析显示病理分期和淋巴细胞减少程度是DFS的独立预后因素（均<0.001）。逻辑回归分析显示低体重指数（BMI）、综合放疗以及高心脏（D≥6 Gy）和胸骨（D≥20 Gy）照射剂量与G3淋巴细胞减少症相关（均<0.05）。
G3级RIL导致乳房切除术后放疗患者DFS较差。BMI、放疗方式以及心脏和胸骨照射剂量是独立的RIL危险因素。
