TY - JOUR
T1 - Lymphocyte Nadir and Esophageal Cancer Survival Outcomes After Chemoradiation Therapy
AU - Davuluri, Rajayogesh
AU - Jiang, Wen
AU - Fang, Penny
AU - Xu, Cai
AU - Komaki, Ritsuko
AU - Gomez, Daniel R.
AU - Welsh, James
AU - Cox, James D.
AU - Crane, Christopher H.
AU - Hsu, Charles C.
AU - Lin, Steven H.
N1 - Funding Information:
Supported in part by The Mabuchi Research Fund and University of Texas MD Anderson Cancer Center and by the National Cancer Institute Cancer Center Support Grant CA016672 .
Funding Information:
Conflict of interest: Dr Welsh reports a leadership role at Molecular Match; stock or other ownership in Helios, Molecular Match, OncoResponse, Reflexion Medical, and Checkmate Pharmaceuticals; a consulting/advisory role for Varian, MAyu, Reflexion Medical, Checkmate Pharmaceuticals, and OncoResponse; research funding from BMS, Merck, Varian, GSK, Incyte, and Calithera; and travel accommodations from OncoResponse and BMS. Dr Gomez reports participation in the Speakers' Bureau for BMS and research funding from Merck. Dr Lin reports research funding from Elekta, Peregrine Pharmaceuticals, STCube Pharmaceuticals, and Roche/Genentech, and receipt of honoraria from AstraZeneca, US Oncology, and ProCure. The other authors report no conflict of interest.
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - 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.
AB - 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.
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U2 - 10.1016/j.ijrobp.2017.05.037
DO - 10.1016/j.ijrobp.2017.05.037
M3 - Article
C2 - 28816138
AN - SCOPUS:85027698628
SN - 0360-3016
VL - 99
SP - 128
EP - 135
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 1
ER -