Wei Deng1, Cai Xu2, Amy Liu3, Peter S N van Rossum4, Weiye Deng5, Zhongxing Liao5, Albert C Koong5, Radhe Mohan3, Steven H Lin6. 1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States; Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. 2. Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, China. 3. Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, United States. 4. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States; Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands. 5. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States. 6. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States. Electronic address: SHLin@mdanderson.org.
Abstract
INTRODUCTION: Radiation-induced lymphopenia (RIL) during therapy is associated with poor prognosis but is often temporary and resolves after treatment completion in esophageal cancer. How lymphocyte recovery contributes to prognosis is unknown. METHODS: We reviewed 755 patients with stage I-III esophageal carcinoma who received concurrent chemoradiation therapy (CRT) with or without surgery in 2004-2015. Complete blood counts were obtained before, during, and at first follow-up after CRT. Lymphopenia was graded per the Common Terminology Criteria for Adverse Events v4.03 during CRT (G) and as recovery after CRT (Gr). Clinical factors and lymphopenia grade were tested for association with survival in univariable and multivariable Cox proportional hazard regression analyses. RESULTS: During CRT, 294 patients (38.9%) had G4 lymphopenia; by the first follow-up, 406 patients (53.8%) had recovered (Gr0-1). Relative to patients with G0-3 lymphopenia during CRT, G4 lymphopenia independently predicted worse OS in multivariable analyses. However, lymphocyte recovery was not associated with a better prognosis. Patients with G4 lymphopenia during CRT and recovery (Gr0-1) afterward still had poorer 5-year OS rate than patients with G0-3 during CRT without recovery (Gr2-4) afterward (36.6% vs. 51.9%, HR = 1.40, 95% CI 1.04-1.89, P = 0.027). Moreover, the lymphocyte recovery ability (post-CRT ALC divided by pre-CRT ALC) was not affected by lymphopenia grade during CRT (0.66 in G0-3 vs. 0.65 in G4, p = 0.473). Among patients with G4 lymphopenia during treatment, lymphocyte recovery was only associated with pre-CRT lymphocyte counts. CONCLUSION: Lymphocyte count recovery after CRT does not alter the poor long-term outcomes brought about by high-grade lymphopenia during CRT.
INTRODUCTION: Radiation-induced lymphopenia (RIL) during therapy is associated with poor prognosis but is often temporary and resolves after treatment completion in esophageal cancer. How lymphocyte recovery contributes to prognosis is unknown. METHODS: We reviewed 755 patients with stage I-III esophageal carcinoma who received concurrent chemoradiation therapy (CRT) with or without surgery in 2004-2015. Complete blood counts were obtained before, during, and at first follow-up after CRT. Lymphopenia was graded per the Common Terminology Criteria for Adverse Events v4.03 during CRT (G) and as recovery after CRT (Gr). Clinical factors and lymphopenia grade were tested for association with survival in univariable and multivariable Cox proportional hazard regression analyses. RESULTS: During CRT, 294 patients (38.9%) had G4 lymphopenia; by the first follow-up, 406 patients (53.8%) had recovered (Gr0-1). Relative to patients with G0-3 lymphopenia during CRT, G4 lymphopenia independently predicted worse OS in multivariable analyses. However, lymphocyte recovery was not associated with a better prognosis. Patients with G4 lymphopenia during CRT and recovery (Gr0-1) afterward still had poorer 5-year OS rate than patients with G0-3 during CRT without recovery (Gr2-4) afterward (36.6% vs. 51.9%, HR = 1.40, 95% CI 1.04-1.89, P = 0.027). Moreover, the lymphocyte recovery ability (post-CRT ALC divided by pre-CRT ALC) was not affected by lymphopenia grade during CRT (0.66 in G0-3 vs. 0.65 in G4, p = 0.473). Among patients with G4 lymphopenia during treatment, lymphocyte recovery was only associated with pre-CRT lymphocyte counts. CONCLUSION: Lymphocyte count recovery after CRT does not alter the poor long-term outcomes brought about by high-grade lymphopenia during CRT.
Authors: Brian De; Ethan B Ludmir; Craig A Messick; Matthew C Cagley; Van K Morris; Prajnan Das; Bruce D Minsky; Cullen M Taniguchi; Grace L Smith; Eugene J Koay; Albert C Koong; Radhe Mohan; Emma B Holliday Journal: J Gastrointest Oncol Date: 2021-10
Authors: Gyu Sang Yoo; Jeong Il Yu; Sungkoo Cho; Youngyih Han; Yoonjin Oh; Do Hoon Lim; Hee Rim Nam; Ji-Won Lee; Ki-Woong Sung; Hyung Jin Shin Journal: Cancer Res Treat Date: 2021-10-15 Impact factor: 5.036