宫颈癌同步放化疗期间中性粒细胞及淋巴细胞最低值的不同预后作用分析

目的 研究宫颈癌同步放化疗(CCRT)期间中性粒细胞及淋巴细胞最低值对预后的影响,为临床治疗提供参考数据。方法 分析2015—2019年间在香港大学深圳医院接受CCRT治疗的 ⅠB1-ⅣA期宫颈癌患者,治疗期间每周查血常规。Kaplan-Meier法计算总生存(OS)并log-rank检验Cox模型进行单因素及多因素预后分析。结果 共入组 87例患者,根据受试者工作特征曲线确定CCRT期间预测OS的中性粒细胞绝对数最低值(ANCn)及淋巴细胞绝对数最低值(ALCn)的分界值。CCRT期间ANCn>2.14×10⁹/L (11例)比≤2.14×10⁹/L (76例)患者 2年OS率低(54.5%∶88.9%,P=0.035);ALCn≤0.2×10⁹/L (38例)比ALCn>0.2×10⁹/L (49例)患者 2年OS率低(75.3%∶90.8%,P=0.008)。多因素分析显示ANCn、ALCn、同期化疗周期数、平均身体放射剂量与OS相关(HR分别为4.487、5.814、0.204、1.296,95%CI分别为 1.404~14.344、1.822~18.554、0.060~0.696、1.125~1.493,P值分别为0.011、0.003、0.011、<0.001)。CCRT前ANC>5.19×10⁹/L更易出现ANCn>2.14×10⁹/L,CCRT前ALC<2.05×10⁹/L更易出现ALCn≤0.2×10⁹/L。结论 CCRT期间ANCn及ALCn具有不同的预后作用及影响因素,治疗期间密切监测血常规,根据其变化情况优化治疗,达到改善患者预后的目的。

Analysis of different prognostic effects of nadirs of neutrophils and lymphocytes during concurrent chemoradiotherapy for cervical cancer

Objective To evaluate the effects of the nadirs of neutrophils and lymphocytes during concurrent chemoradiotherapy (CCRT) on clinical prognosis of patients with cervical cancer,aiming to provide reference data for clinicians. Methods Clinical data of FIGO (2018)ⅠB1-ⅣA cervical cancer patients treated with radical CCRT inthe University of Hong Kong-Shenzhen Hospital,from January 2015 to September 2019 were analyzed. Routine blood test was performed weekly. The overall survival (OS) was calculated by Kaplan-Meier methodand analyzedby log-rank test.Univariate andMultivariate prognostic analysis were performed by Cox proportional hazards model. Results A total of 87 patients were included. The cutoff values of absolute neutrophil count nadir (ANCn) and absolute lymphocyte count nadir (ALCn) for predicting OS were determined by receiver operating characteristic curve. Compared with the ANCn of ≤2.14×10⁹/L (n=76), patients with the ANCn of > 2.14×10⁹/L (n=11) had lower 2-year OS rate (54.5% vs. 88.9%,P=0.035). Compared with ALCn of > 0.2×10⁹/L (n=49), patients with ALCn of ≤0.2×10⁹/L (n=38) obtained lower 2-year OS rate (75.3% vs. 90.8%,P=0.008). Multivariate analysis showed that ANCn (>2.14×10⁹/L vs. ≤2.14×10⁹/L)(HR=4.487,95%CI:1.404-14.344,P=0.011),ALCn (≤0.2×10⁹/L vs. >0.2×10⁹/L)(HR=5.814,95%CI:1.822-18.554,P=0.003),concurrent chemotherapy cycle (5-6 cycles vs. 0-4 cycles)(HR=0.204,95%CI:0.060-0.696,P=0.011) and the mean body radiation dose (HR=1.296,95%CI:1.125-1.493,P<0.001) were significantly associated with OS. Patients with the ANC of > 5.19×10⁹/L before CCRT were more likely to have ANCn of > 2.14×10⁹/L during CCRT and those with the ALC of < 2.05×10⁹/L before CCRT was more likely to have ALCn of ≤0.2×10⁹/L during CCRT. Conclusions Peripheral ANCn and ALCn during CCRT have different prognostic effects and influencing factors. Clinical prognosis of cervical cancer patients may be improved by closely monitoring routine blood parameters and optimizing treatment modality during CCRT.