食管鳞癌新辅助放化疗后淋巴细胞下降与病理反应相关性分析

目的 分析胸段食管鳞癌新辅助放化疗期间淋巴细胞下降与病理完全缓解率(pCR)的关系。方法 回顾分析2002-2016年期间接受新辅助放化疗联合手术治疗的胸段食管鳞癌患者220例,并采集新辅助放化疗前至放疗后1个月的淋巴细胞计数。淋巴细胞下降程度根据CTCAE 4.0标准进行分级。采用χ²检验和Cox回归模型分析淋巴细胞下降与pCR和复发的关系。结果 全组共95例患者(43.2%)在新辅助放化疗后达到pCR,71例(32.3%)患者术后出现复发。放化疗期间0、1、2、3、4级淋巴细胞下降的发生率分别为1.8%、6.8%、31.4%、38.2%、21.8%。4级淋巴细胞下降者的pCR率显著低于0-3级(22.9% ∶48.8%,P=0.001);此外,前者的术后复发风险显著高于后者(45.8%∶28.5%,P=0.023)。多因素分析显示原发肿瘤长度、肿瘤部位、放疗剂量是食管癌患者放疗期间发生4级淋巴细胞下降的预测因素(P=0.013、0.001、0.002)。结论 新辅助放化疗期间发生4级淋巴细胞下降的食管鳞癌患者的pCR率较低且复发风险较高。淋巴细胞下降可作为一种经济、有效的pCR预测指标。

Correlation between treatment-related lymphopenia and pathologic response in esophageal squamous cell carcinoma patients undergoing neoadjuvant chemoradiotherapy

Objective To investigate the relationship between treatment-related lymphopenia and pathologic complete response (pCR) to neoadjuvant chemoradiotherapy (CRT) in patients with esophageal squamous cell carcinoma (ESCC). Methods Clinical data of 220 ESCC patients treated with neoadjuvant CRT followed by surgery between 2002 and 2016 were retrospectively analyzed. Absolute lymphocyte count was determined before and at 1 month after neoadjuvant CRT. Treatment-related lymphopenia was graded using Common Terminology Criteria for Adverse Events (CTCAE, 4.0 version). The relationship between lymphopenia, pCR and recurrence was evaluated by chi-square test and Cox’s regression model. Results Ninety-five patients (43.2%) achieved a pCR after neoadjuvant CRT and 71 cases (32.3%) recurred postoperatively. During neoadjuvant CRT, the incidence rates of grade 0,1,2,3,and 4 lymphopenia were 1.8%,6.8%,31.4%,38.2%,and 21.8%,respectively. Patients with grade 4 lymphopenia had a significantly lower pCR rate than those with grade 0-3 lymphopenia (22.9% vs.48.8%,P=0.001). Moreover, grade 4 lymphopenia was significantly associated with a higher risk of recurrence (45.8% vs.28.5%,P=0.023). Multivariate analysis identified that primary tumor length, tumor location and radiation dose were the independent predictors for grade 4 lymphopenia during neoadjuvant CRT (P=0.013,0.001,0.002). Conclusions The incidence of grade 4 lymphopenia in ESCC patients undergoing neoadjuvant CRT is correlated with a low pCR rate and a high risk of recurrence. Lymphopenia can be used as an economic and effective predictor for pCR.