The Association Between Chemoradiation-related Lymphopenia and Clinical Outcomes in Patients With Locally Advanced Pancreatic Adenocarcinoma.
The Association Between Chemoradiation-related Lymphopenia and Clinical Outcomes in Patients With Locally Advanced Pancreatic Adenocarcinoma.
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DOI：
10.1097/coc.0b013e3182940ff9
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发表时间：
2015-06
期刊：
影响因子：
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通讯作者：
Herman JM
中科院分区：
文献类型：
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作者：
Wild AT;Ye X;Ellsworth SG;Smith JA;Narang AK;Garg T;Campian J;Laheru DA;Zheng L;Wolfgang CL;Tran PT;Grossman SA;Herman JM
淋巴细胞减少是放化疗的常见后果，但很少在临床上得到解决。本研究旨在确定局部晚期胰腺癌（LAPC）患者接受明确放化疗后是否会出现明显的淋巴细胞减少，以及这是否会影响临床结果。回顾性分析1997年至2011年在同一医院接受放化疗的LAPC患者。总淋巴细胞计数（TLCs）记录在基线和每月期间和放化疗后。采用单变量Cox回归分析，分析治疗性淋巴细胞减少症、已确定的预后因素和总生存率之间的相关性。选取经单因素分析确定的重要因素作为协变量，构建多因素生存比例风险模型。共有101例患者符合入选标准。放化疗前，86%的患者TLCs正常。开始放化疗2个月后，每位患者的TLC平均减少50.6% (SD, 40.6%) (P< 0.00001)， 46%的患者TLC< 500细胞/mm3。开始放化疗2个月后TLC < 500 cells/mm3的患者中位生存期（8.7 vs. 13.3mo， P= 0.03）和PFS （4.9 vs. 9.0mo， P= 0.15）较差。多因素分析显示，TLC< 500 cells/mm3与基线血清白蛋白（HR= 3.584， P= 0.0002）、BUN （HR= 1.060， P= 0.02）、血小板计数（HR= 1.004， P= 0.005）、放射计划靶体积（HR= 1.003， P= 0.0006）是不良生存期的独立预测因子（HR= 2.879， P= 0.001）。严重的治疗相关淋巴细胞减少在LAPC放化疗后经常发生，是低生存率的独立预测因子。
Lymphopenia is a common consequence of chemoradiation therapy yet is seldom addressed clinically. This study was conducted to determine if patients with locally advanced pancreatic cancer (LAPC) treated with definitive chemoradiation develop significant lymphopenia and if this affects clinical outcomes. A retrospective analysis of patients with LAPC treated with chemoradiation at a single institution from 1997 to 2011 was performed. Total lymphocyte counts (TLCs) were recorded at baseline and then monthly during and after chemoradiation. The correlation between treatment-induced lymphopenia, established prognostic factors, and overall survival was analyzed using univariate Cox regression analysis. Important factors identified by univariate analysis were selected as covariates to construct a multivariate proportional hazards model for survival. A total of 101 patients met eligibility criteria. TLCs were normal in 86% before chemoradiation. The mean reduction in TLC per patient was 50.6% (SD, 40.6%) 2 months after starting chemoradiation (P< 0.00001), and 46% had TLC< 500 cells/mm3. Patients with TLC < 500 cells/mm3 2 months after starting chemoradiation had inferior median survival (8.7 vs. 13.3mo, P= 0.03) and PFS (4.9 vs. 9.0mo, P = 0.15). Multivariate analysis revealed TLC< 500 cells/mm3 to be an independent predictor of inferior survival (HR= 2.879, P= 0.001) along with baseline serum albumin (HR= 3.584, P = 0.0002), BUN (HR = 1.060, P= 0.02), platelet count (HR= 1.004, P = 0.005), and radiation planning target volume (HR= 1.003, P= 0.0006). Severe treatment-related lymphopenia occurs frequently after chemoradiation for LAPC and is an independent predictor of inferior survival.