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Cancer Res Treat. 2018 Jan;50(1):19-29. doi: 10.4143/crt.2016.595. Epub 2017 Apr 5.

The Prognostic Value of Treatment-Related Lymphopenia in Nasopharyngeal Carcinoma Patients.

Liu LT1,2, Chen QY1,2, Tang LQ1,2, Guo SS1,2, Guo L1,2, Mo HY1,2, Chen MY1,2, Zhao C1,2, Guo X1,2, Qian CN1,2, Zeng MS1, Bei JX1, Tan J1, Chen S1, Hong MH1,3, Shao JY1,4, Sun Y1,5, Ma J1,5, Mai HQ1,2.

Author information

1
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.
2
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China.
3
Good Clinical Practice Center, Sun Yat-Sen University Cancer Center, Guangzhou, China.
4
Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, Guangzhou, China.
5
Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.

Abstract

PURPOSE:

This study was conducted to evaluate the prognostic value of treatment-related lymphopenia in patients with nasopharyngeal carcinoma (NPC).

MATERIALS AND METHODS:

A total of 413 consecutive stage II-IVb NPC patients treated with concurrent chemoradiotherapy (CCRT) were enrolled. The overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) were calculated with the Kaplan-Meier method, and differences were compared using the log-rank test.

RESULTS:

A minimum (mini)-absolute lymphocyte counts (ALC) of < 390 cells/μL or ALC after 3 months of CCRT (post3m-ALC) < 705 cells/μL was significantly associated with worse outcome than mini-ALC ≥ 390 cells/μL (OS, p=0.002; PFS, p=0.005; DMFS, p=0.004) or post3m-ALC ≥ 705 cells/μL (OS, p < 0.001; PFS, p < 0.001; DMFS, p=0.001). Patients with lymphopenia (mini-ALC < 390 cells/μL and post3m-ALC < 705 cells/μL) had a worse prognosis than those without lymphopenia (mini-ALC ≥ 390 cells/μL and post3m-ALC ≥ 705 cells/μL) (OS, p < 0.001; PFS, p < 0.001; DMFS, p < 0.001). Multivariate analysis revealed that post3m-ALC was an independent prognostic factor for OS (hazard ratio [HR], 1.76; 95% confidence interval [CI], 1.12 to 2.78; p=0.015), PFS (HR, 1.86; 95% CI, 1.23 to 2.82; p=0.003), and DMFS (HR, 1.87; 95% CI, 1.13 to 3.08; p=0.014). Multivariate analysis also revealed that patients with lymphopenia had a high risk of death (HR, 3.79; 95% CI, 1.75 to 8.19; p=0.001), disease progression (HR, 2.93; 95% CI, 1.59 to 5.41; p=0.001), and distant metastasis (HR, 3.89; 95% CI, 1.67 to 9.10; p=0.002). Multivariate analysis performed with time dependent Cox regression demonstrated ALC was an independent prognostic factor for OS (HR, 0.995; 95% CI, 0.991 to 0.999; p=0.025) and PFS (HR, 0.993; 95% CI, 0.988 to 0.998; p=0.006).

CONCLUSION:

Treatment-related lymphopenia was a poor prognostic factor in NPC patients.

KEYWORDS:

Lymphopenia; Nasopharyngeal carcinoma; Radiotherapy; Survival

PMID:
28392551
PMCID:
PMC5784643
DOI:
10.4143/crt.2016.595
[Indexed for MEDLINE]
Free PMC Article

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