The effect of long-standing lymphopenia after radiation therapy on survival in rectal cancer

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford Pub Date : 2024-08-08 DOI:10.1016/j.suronc.2024.102119

Viacheslav Soyfer , Eli Lugovoy , Alla Nikolaevski-Berlin , Yasmin Korzets , Albert Schlocker , Orit Gutfeld , Inna Ospovat , Uri Amit , Tatiana Rabin , Yasmin Filomena Natan-Oz , Leor Zach , Ofer Merimsky , Ravit Geva , Sharon Peles , Ido Wolf

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引用次数: 0

Abstract

Background

Lymphopenia and high neutrophil-to-lymphocyte ratio are known negative prognostic factors in rectal cancer. Until recently, however, lymphopenia was regarded as a minor sequela following radiation therapy (RT). The immune system's influence on rectal cancer treatment outcomes led us to evaluate the impact of lymphopenia at various time points, before, during, and following radiotherapy. We hypothesized that chronic lymphopenia following radiotherapy might negatively influence the survival of patients, and pre-treatment lymphopenia may be predictive of poor outcomes.

Methods

This retrospective study involved 110 patients treated for rectal cancer between 2015 and 2019. The oncological outcomes are defined as alive without disease (AWOD), alive with disease (AWD), and death. These outcome probabilities tested against variables of lymphopenia before RT, during RT, and at several post-RT follow-up time points.

Results

At the end of the study, 69 patients were AWOD (63 %), 13 were AWD (12 %) and 28 had died (25 %). Treatment results were assessed with according level of lymphocytes measured one year following RT: 35 out of 39 patients (89.7 %) with normal values were AWOD. In 65 patients with sustained lymphopenia, 52 % were AWOD, 18.5 % AWD and 29 % died. A similar difference was found at all time-points up to 2 years following RT (p < 0.004).

The results of our study shows that pre-existing lymphopenia (prior to RT) is associated with a 3 times greater chance of death compared to patients with normal lymphocyte levels prior to RT. The PFS significantly affected by lymphopenia at all time-points after RT. An NLR of more than 4 was associated with a 3-time higher risk of recurrence than lower NLR scores (p = 0.0054).

Conclusion

Our results support the relevance of lymphopenia and NLR in the prognosis of rectal cancer. We believe this is the first study showing a negative correlation between sustained lymphopenia and OS following RT.

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放疗后长期淋巴细胞减少对直肠癌患者生存的影响

背景淋巴细胞减少症和中性粒细胞与淋巴细胞比率过高是已知的直肠癌预后不良因素。然而，直到最近，淋巴细胞减少症仍被视为放疗（RT）后的次要后遗症。免疫系统对直肠癌治疗结果的影响促使我们评估淋巴细胞减少症在放疗前、放疗中和放疗后不同时间点的影响。我们假设，放疗后的慢性淋巴细胞减少症可能会对患者的生存产生负面影响，而治疗前的淋巴细胞减少症可能是不良预后的预测因素。方法这项回顾性研究涉及 2015 年至 2019 年期间接受治疗的 110 例直肠癌患者。肿瘤结局被定义为无病生存（AWOD）、有病生存（AWD）和死亡。这些结果概率根据 RT 前、RT 期间和 RT 后多个随访时间点的淋巴细胞减少变量进行测试。结果在研究结束时，69 名患者无病存活（63%），13 名患者有病存活（12%），28 名患者死亡（25%）。治疗结果根据 RT 一年后测量的淋巴细胞水平进行评估：在 39 名淋巴细胞值正常的患者中，有 35 人（89.7%）为 AWOD。在 65 名淋巴细胞持续减少的患者中，52% 的患者为 AWOD，18.5% 的患者为 AWD，29% 的患者死亡。我们的研究结果表明，与 RT 前淋巴细胞水平正常的患者相比，RT 前淋巴细胞减少症患者的死亡几率要高出 3 倍。淋巴细胞减少症对 RT 后所有时间点的 PFS 都有明显影响。我们的结果支持淋巴细胞减少症和 NLR 与直肠癌预后的相关性。我们相信，这是第一项显示持续淋巴细胞减少与 RT 术后 OS 负相关的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Oncology-Oxford 医学-外科

CiteScore

4.50

自引率

0.00%

发文量

169

审稿时长

38 days

期刊介绍： Surgical Oncology is a peer reviewed journal publishing review articles that contribute to the advancement of knowledge in surgical oncology and related fields of interest. Articles represent a spectrum of current technology in oncology research as well as those concerning clinical trials, surgical technique, methods of investigation and patient evaluation. Surgical Oncology publishes comprehensive Reviews that examine individual topics in considerable detail, in addition to editorials and commentaries which focus on selected papers. The journal also publishes special issues which explore topics of interest to surgical oncologists in great detail - outlining recent advancements and providing readers with the most up to date information.