Efficacy of cancer chemotherapy in relation to the pretreatment number of lymphocytes in patients with metastatic solid tumors
Efficacy of cancer chemotherapy in relation to the pretreatment number of lymphocytes in patients with metastatic solid tumors
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DOI：
10.1177/172460080401900208
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发表时间：
2004-04-01
影响因子：
2
通讯作者：
Gardani, GS
中科院分区：
文献类型：
--
作者：
Lissoni, P;Brivio, F;Gardani, GS
淋巴细胞减少症的证据已被证明预测预后不良的生存晚期癌症患者。这一发现并不奇怪，因为淋巴细胞在介导肿瘤细胞破坏中起着重要作用。尽管淋巴细胞在癌症发病机制中的重要性，但关于淋巴细胞在各种抗肿瘤治疗期间的概况和功能的数据很少，特别是淋巴细胞预处理数量和对化疗的反应之间的关系仍有待建立。本研究旨在评估治疗开始前淋巴细胞减少的证据是否可能影响受最常见肿瘤类型影响的转移性癌症患者的化疗疗效。该研究包括183名患者（肺癌：89名;结直肠癌：63名;乳腺癌：31名），其中95名患者先前接受过化疗。化疗方案包括：未治疗的结直肠癌患者接受奥沙利铂+5-氟尿嘧啶和叶酸，预治疗的结直肠癌患者接受伊立替康每周一次，未治疗的肺癌患者接受顺铂+吉西他滨或依托泊苷，预治疗的肺癌患者接受长春瑞滨每周一次，既往接受过蒽环类药物治疗的乳腺癌患者接受泰索帝。淋巴细胞计数低于1500/mm时被认为异常低（3）。在79/183（43%）例患者中发现淋巴细胞减少症，与肿瘤组织学无任何显著差异。104例淋巴细胞计数正常的患者中有6例达到完全缓解（CR），79例淋巴细胞减少症患者中无一例达到CR。在39例淋巴细胞计数正常的患者中获得了部分应答（PR），仅在8例治疗前淋巴细胞计数低的患者中获得了部分应答（PR）。因此，无论化疗类型如何，淋巴细胞减少患者的客观肿瘤缓解率（CR + PR）明显低于治疗前淋巴细胞计数正常的患者（8/79 vs 45/104; p
The evidence of lymphocytopenia has been demonstrated to predict a poor prognosis in terms of survival in advanced cancer patients. This finding is not surprising because of the fundamental role of lymphocytes in mediating tumor cell destruction. Despite the importance of lymphocytes in the pathogenesis of cancer, there are only few data about the profile and the function of lymphocytes during the various antitumor therapies, and in particular the relation between lymphocyte pretreatment number and response to chemotherapy remains to be established. The present study was performed to evaluate whether the evidence of lymphocytopenia before the onset of treatment may influence the efficacy of chemotherapy in metastatic cancer patients affected by the most frequent tumor types. The study included 183 patients (lung cancer: 89; colorectal cancer: 63; breast cancer: 31), 95 of whom had been previously treated with chemotherapy. The chemotherapeutic regimens consisted of oxaliplatin plus 5-fluorouracil and folates in untreated colorectal cancer, weekly irinotecan in pretreated colorectal cancer, cisplatin plus gemcitabine or etoposide in untreated lung cancer, weekly vinorelbine in pretreated lung cancer, and taxotere in breast cancer patients who had been previously treated with anthracyclines. Lymphocyte count was considered to be abnormally low for values below 1500/mm(3). Lymphocytopenia was found in 79/183 (43%) patients, without any significant differences in relation to tumor histology. A complete response (CR) was achieved in 6/104 patients with a normal lymphocyte count and in none of the 79 lymphocytopenic patients. A partial response (PR) was obtained in 39 patients with a normal lymphocyte count and in only eight patients with a low lymphocyte count prior to therapy. Therefore, irrespective of the type of chemotherapy, the objective tumor response rate (CR + PR) in lymphocytopenic patients was significantly lower than in patients with normal pretreatment lymphocyte counts (8/79 vs 45/104; p