Li Shu-Guang, Liu Yang, Zhang Xue-Yuan, Li You-Mei, Shen Wen-Bin, Zhu Shu-Chai
Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China.
World J Gastrointest Oncol. 2025 Jul 15;17(7):108205. doi: 10.4251/wjgo.v17.i7.108205.
Definitive chemoradiotherapy is the standard treatment for unresectable, locally advanced esophageal cancer. However, radiotherapy (RT) often affects the immune system of patients. One of the possible mechanisms of lymphopenia after RT is that a large number of circulating lymphocytes in the systemic and pulmonary circulation will be killed by more sessions of low-dose radiation. The impact of dose-volume parameters of organs at risk (OARs) on absolute lymphocyte count (ALC) and the relationship between the extent of lymphocyte count reduction and survival prognosis in patients with middle and lower thoracic esophageal squamous cell carcinoma (ESCC) both remain difficult to determine.
To determine the relationship between RT parameters, lymphocyte count and survival prognosis of esophageal cancer patients.
The clinical data of 112 patients with stage I-III ESCC who received definitive RT were analyzed retrospectively. The ALC values before RT, weekly during RT, and within 1 month after RT were determined. Logistic regression was used to evaluate the correlation between the parameters of radiation OARs and the lowest point of the ALC. Kaplan-Meier and Cox regression analyses were used to evaluate the relationship between the lowest point of the ALC and patient survival during RT.
The median value of the ALC before treatment was 1.57 × 10 cells/L, and 32 patients (28.6%) showed grade 4 ALC reduction during RT. The reduction in G4 ALC during RT was significantly associated with poor overall survival (OS) and progression-free survival. Multivariate analysis showed that stage III tumors ( = 0.003), high heart V ( = 0.046), high lung V ( = 0.048), and high lung V ( = 0.031) were associated with G4 ALC reduction during RT.
The reduction in G4 ALC is related to OS. Joint evaluation of the tumor stage and dose volume parameters has predictive value for G4 ALC reduction and OS.
根治性放化疗是不可切除的局部晚期食管癌的标准治疗方法。然而，放疗（RT）常常会影响患者的免疫系统。放疗后淋巴细胞减少的一种可能机制是，全身和肺循环中的大量循环淋巴细胞会因更多疗程的低剂量辐射而被杀死。危及器官（OARs）的剂量体积参数对绝对淋巴细胞计数（ALC）的影响以及中下段食管鳞状细胞癌（ESCC）患者淋巴细胞计数减少程度与生存预后之间的关系仍难以确定。
确定放疗参数、淋巴细胞计数与食管癌患者生存预后之间的关系。
回顾性分析112例接受根治性放疗的I - III期ESCC患者的临床资料。测定放疗前、放疗期间每周以及放疗后1个月内的ALC值。采用逻辑回归评估放疗OARs参数与ALC最低点之间的相关性。采用Kaplan - Meier法和Cox回归分析评估ALC最低点与放疗期间患者生存之间的关系。
治疗前ALC的中位数为1.57×10⁹细胞/L，32例患者（28.6%）在放疗期间出现4级ALC降低。放疗期间4级ALC降低与总生存期（OS）和无进展生存期较差显著相关。多因素分析显示，III期肿瘤（P = 0.003）、高心脏V（P = 0.046）、高肺V20（P = 0.048）和高肺V30（P = 0.031）与放疗期间4级ALC降低相关。
4级ALC降低与OS相关。肿瘤分期和剂量体积参数的联合评估对4级ALC降低和OS具有预测价值。
