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  

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

作　　者：王修身 张羲茜 习勉[2] 卜珊珊[3] Wang Xiushen;Zhang Xixi;Xi Mian;Bo Shanshan(Department of Radiation Oncology. Affiliated Cancer Hospital of Zhengzhou liniversity,Zhengzhou 450008,China;Department of Radiation Oncology,Sun Yat-sen University Cancer Center,Guangzhou 510060,China;Department of Radiation Oncology,Henan Provincial Cancer Hospital,Zhengzhou 450008,China)

机构地区：[1]郑州大学附属肿瘤医院放疗科,450008 [2]中山大学肿瘤防治中心放疗科,广州510060 [3]河南省肿瘤医院放疗科,郑州450008

出　　处：《中华放射肿瘤学杂志》2019年第4期274-279,共6页Chinese Journal of Radiation Oncology

摘　　要：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χ^2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。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.

关 键 词：食管肿瘤/新辅助放化疗法 淋巴细胞下降 病理反应 

分 类 号：R730.55[医药卫生—肿瘤] R735.1[医药卫生—临床医学]