Lymphocyte nadir and esophageal cancer survival outcomes after chemoradiation therapy Journal Article

Authors: Davuluri, R.; Jiang, W.; Fang, P.; Xu, C.; Komaki, R.; Gomez, D. R.; Welsh, J.; Cox, J. D.; Crane, C. H.; Hsu, C. C.; Lin, S. H.
Article Title: Lymphocyte nadir and esophageal cancer survival outcomes after chemoradiation therapy
Abstract: Purpose Host immunity may affect the outcome in patients with esophageal cancer. We sought to identify factors that influenced absolute lymphocyte count (ALC) nadir during chemoradiation therapy (CRT) for esophageal cancer (EC) and looked for clinically relevant associations with survival. Methods and Materials 504 patients with stage I-III EC (2007-2013) treated with neoadjuvant or definitive CRT with weekly ALC determinations made during treatment were analyzed. Grade of lymphopenia from ALC nadir during CRT was based on Common Terminology Criteria for Adverse Events version 4.0. Associations of ALC nadir with survival were examined using multivariate Cox proportional hazards analysis (MVA) and competing risks regression analysis. Results The median follow-up time was 36 months. The incidences of grade 1, 2, 3, and 4 ALC nadir during CRT were 2%, 12%, 59%, and 27%, respectively. The impact was lymphocyte-specific because this was not seen for monocyte or neutrophil count. On MVA, grade 4 ALC nadir (G4 nadir) was significantly associated with worse overall and disease-specific survival outcomes. Predictors of G4 nadir included distal tumor location, definitive CRT, taxane/5-fluorouracil chemotherapy, and photon-based radiation type (vs proton-based). Radiation type strongly influenced the mean body dose exposure, which was a strong predictor for G4 nadir (odds ratio 1.22 per Gray, P<.001). Conclusions G4 nadir during CRT for EC was associated with poor outcomes, suggesting a role of host immunity in disease control. This observation provides a rationale to prospectively test chemotherapeutic and radiation treatment strategies that may have a lower impact on host immunity. © 2017 Elsevier Inc.
Keywords: treatment outcome; middle aged; retrospective studies; mortality; carcinoma, squamous cell; fluorouracil; chemotherapy; adenocarcinoma; t lymphocyte; t-lymphocytes; proportional hazards models; radiotherapy dosage; radiotherapy; incidence; odds ratio; pathology; retrospective study; radiation response; risk assessment; immunology; proportional hazards model; neutrophil; neutrophils; platinum derivative; taxoids; kaplan meier method; platinum compounds; monocyte; monocytes; patient treatment; disease control; regression analysis; lymphocytes; lymphopenia; risk analysis; diseases; esophageal neoplasms; lymphocyte count; chemoradiotherapy; esophageal cancer; taxoid; radiation treatments; adverse effects; kaplan-meier estimate; proportional hazards; proton therapy; drug products; common terminology criteria; procedures; competing risks; drug effects; methods and materials; humans; human; disease-specific survivals; chemoradiation therapies
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 99
Issue: 1
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2017-09-01
Start Page: 128
End Page: 135
Language: English
DOI: 10.1016/j.ijrobp.2017.05.037
PUBMED: 28816138
PROVIDER: scopus
Notes: Article -- Export Date: 5 September 2017 -- Source: Scopus
Citation Impact
MSK Authors
  1. Chanxing Wilson Xu
    8 Xu
  2. Charles Chia-Chuen Hsu
    2 Hsu
  3. Daniel R Gomez
    142 Gomez
  4. Chao   Xu
    4 Xu
  5. Christopher   Crane
    136 Crane