放疗相关淋巴细胞减少症对不可手术切除原发性肝癌放疗预后的预测价值  

Prognostic Value of Radiation-Induced Lymphopenia in Patients with Unresectable Primary Hepatocellular Carcinoma Receiving Radiotherapy

作　　者：童金龙 王海玉 田小强 李英[1] 鲁世慧 叶伟 TONG Jinlong;WANG Haiyu;TIAN Xiaoqiang;LI Ying;LU Shihui;YE Wei(Department No.1 of Oncology,The Affiliated Nanjing Hospital of Nanjing University of Chinese Medicine(Nanjing Second Hospital),Nanjing 210003,China;Department of Radiotherapy,The Affiliated Nanjing Hospital of Nanjing University of Chinese Medicine(Nanjing Second Hospital),Nanjing 210003,China;Liver Cirrhosis Treatment Center,The Affiliated Nanjing Hospital of Nanjing University of Chinese Medicine(Nanjing Second Hospital),Nanjing 210003,China)

机构地区：[1]南京中医药大学附属南京医院(南京市第二医院)肿瘤一科,南京210003 [2]南京中医药大学附属南京医院(南京市第二医院)放疗科,南京210003 [3]南京中医药大学附属南京医院(南京市第二医院)肝硬化治疗中心,南京210003

出　　处：《肿瘤防治研究》2024年第12期1007-1014,共8页Cancer Research on Prevention and Treatment

基　　金：吴阶平医学基金会临床科研专项(320.6750.2024-19-12);南京市第二医院后备人才项目(HBRCYL05)。

摘　　要：目的分析放疗相关淋巴细胞减少症对接受放射治疗的原发性肝癌患者的预后预测价值。方法回顾性分析接受放疗的98例不可手术切除原发性肝癌患者的临床资料,根据CTCAE V4.0对最低绝对淋巴细胞计数(min ALC)进行分级,采用受试者工作特征曲线确定对患者预后判断的最佳min ALC阈值,分析min ALC与临床特征、剂量学参数的相关性,Kaplan-Meier法分析不同水平min ALC的患者生存情况,单、多因素Cox风险比例回归模型分析相关预后因素。结果98例患者放疗前ALC与min ALC分别为1.52×10^(9)/L和0.45×10^(9)/L,差异有统计学意义(P<0.001),min ALC预测1年生存率的最佳临界值为0.38×10^(9)/L,GTV、肝脾平均剂量、肝脾V5和V10、脾V15与minALC相关,肝V5是minALC的独立预测因子;>min ALC患者总生存率优于≤min ALC患者,放疗后min ALC≤0.38×10^(9)/L(HR=0.515,P=0.024)、min ALC≥3级(HR=0.576,P=0.032)、门/腔静脉癌栓、Child-Pugh A级、放疗后Child-Pugh评分增加≥2分以及接受≥2种其他治疗均为独立预后因素。结论放疗后min ALC≤0.38×10^(9)/L、min ALC≥3级对接受放疗的不可手术肝癌患者均有独立预后判断价值。Objective To evaluate the prognostic value of radiation-induced lymphocytopenia in the survival of patients with primary hepatocellular carcinoma receiving radiation therapy.Methods The clinical data of 98 patients with unresectable primary hepatocellular carcinoma who received radiotherapy were retrospectively analyzed.The minimum absolute lymphocyte count(min ALC)was graded in accordance with CTCAE V4.0.The optimal threshold of min ALC for prognosis was calculated by using the receiver operating characteristic curve,and the correlation of min ALC with clinical characteristics and dosimetry parameters was analyzed.The Kaplan-Meier method was employed to analyze the survival of patients with different levels of min ALC.Univariate and multivariate Cox proportional regression models were applied to analyze prognostic factors.Results The baseline and min ALC of 98 patients during radiotherapy were 1.52×10^(9)/L and 0.45×10^(9)/L,respectively(P<0.001).The optimal cut-off value of min ALC for the prediction of the one-year survival rate was 0.38×10^(9)/L.GTV,the mean dose of the liver and spleen,the V5 and V10 of the liver and spleen,and the V15 of the spleen were correlated with min ALC,and the V5 of the liver was an independent predictor of min ALC.The overall survival of patients with high min ALC was higher than that of patients with low min ALC.Independent prognostic factors were min ALC≤0.38×10^(9)/L(HR=0.515,P=0.024),min ALC≥grade 3(HR=0.576,P=0.032),tumor thrombus in the portal/vena cava,Child-Pugh grade A,increase of≥2 points in the Child-Pugh score after radiotherapy,and received more than two other therapies.Conclusion Min ALC≤0.38×10^(9)/L and min ALC≥grade 3 have independent prognostic value in patients with unresectable hepatocellular carcinoma receiving radiotherapy.

关 键 词：原发性肝癌 放射治疗 放疗相关淋巴细胞减少症 预后 

分 类 号：R735.7[医药卫生—肿瘤] R730.55[医药卫生—临床医学]