Reduction of circulating lymphocyte count is a predictor of good tumor response after neoadjuvant treatment for rectal cancer.
Reduction of circulating lymphocyte count is a predictor of good tumor response after neoadjuvant treatment for rectal cancer.
复制标题
循环淋巴细胞计数的减少是直肠癌新辅助治疗后良好肿瘤反应的预测因子
DOI：
10.1097/md.0000000000011435
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发表时间：
2018-09
期刊：
影响因子：
1.6
通讯作者：
Deng Y
中科院分区：
文献类型：
--
作者：
Wu Z;Zhang J;Cai Y;Deng R;Yang L;Li J;Deng Y
摘要 全身炎症指标与癌症患者的不良预后相关。肿瘤组织内部和周围存在淋巴细胞是直肠癌的预测因子。我们的目的是探索新辅助治疗期间循环淋巴细胞变化的机制以及计数与肿瘤反应的相关方式。训练和验证组中包括来自 FOWARC 试验的约 307 名患者和来自 FORTUNE 试验的 64 名患者。在新辅助治疗前和直肠手术前记录循环淋巴细胞计数。进行受试者工作特征（ROC）曲线分析以确定淋巴细胞减少的最佳截止值。通过多变量分析得到逻辑回归模型。治疗前后血液淋巴细胞绝对数与肿瘤反应无相关性。然而，FOWARC 队列中，良好反应组的总淋巴细胞计数 (TLC) 减少量显着更高（39.81% vs 33.31% P = .032）。 TLC 的最佳截断值为 24.96%。年龄、肿瘤长度和 TLC 减少（P = .005，OR = 2.009，95%CI 1.240–3.254）是多变量分析中肿瘤消退的重要因素。在《财富》队列中，单变量（P = .032，OR = 3.434，95%CI 1.111–10.614）和多变量分析（P = .046，OR = 3.361，95%CI）中，TLC 减少是肿瘤消退的唯一显着因素。 1.024–11.035）。在局部晚期直肠癌的新辅助治疗期间，循环淋巴细胞计数减少，这与更好的肿瘤消退有关。它可能参与放疗和化疗引起的免疫反应。
Abstract Systemic inflammatory indices are correlated with poor prognosis in cancer patients. The presence of lymphocytes in and around the tumor tissue is a predictor in rectal cancer. We aimed to explore the mechanism underlying the changes in circulating lymphocyte during neoadjuvant therapy and the way in which the count correlates with tumor response. Around 307 patients from FOWARC trial and 64 patients from FORTUNE trial were included in the training and validation group. Circulating lymphocyte count was recorded before neoadjuvant therapy and before rectal surgery. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off value of the reduction of lymphocytes. A logistic regression model was obtained in multivariate analysis. The blood absolute number of lymphocyte before and after therapy had no correlation with tumor response. However, total lymphocyte count (TLC) reduction was significantly higher in good response group (39.81% vs 33.31% P = .032) in the FOWARC cohort. The optimal cut-off value for TLC was 24.96%. Age, tumor length, and TLC reduction (P = .005, OR = 2.009, 95%CI 1.240–3.254) were significant factors for tumor regression in multivariate analysis. In the FORTUNE cohort, TLC reduction was the only significant factor for tumor regression in both univariate (P = .032, OR = 3.434, 95%CI 1.111–10.614) and multivariate analysis (P = .046, OR = 3.361, 95%CI 1.024–11.035). Circulating lymphocyte count decreases during neoadjuvant therapy for locally advanced rectal cancer, and it is associated with better tumor regression. It may be involved in the immune response provoked by radiotherapy and chemotherapy.