Cancer Res Treat.  2018 Jan;50(1):19-29. 10.4143/crt.2016.595.

The Prognostic Value of Treatment-Related Lymphopenia in Nasopharyngeal Carcinoma Patients

• Liu LT
• Chen QY
• Tang LQ
• Guo SS
• Guo L
• Mo HY
• Chen MY
• Zhao C
• Guo X
• Qian CN
• Zeng MS
• Bei JX
• Tan J
• Chen S
• Hong MH
• Shao JY
• Sun Y
• Ma J
• Mai HQ

• KMID: 2403471
• DOI: http://doi.org/10.4143/crt.2016.595

Abstract

PURPOSE
This study was conducted to evaluate the prognostic value of treatment-related lymphopenia in patients with nasopharyngeal carcinoma (NPC).
MATERIALS AND METHODS
A total of 413 consecutive stage II-IVb NPC patients treated with concurrent chemoradiotherapy (CCRT) were enrolled. The overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) were calculated with the Kaplan-Meier method, and differences were compared using the log-rank test.
RESULTS
A minimum (mini)-absolute lymphocyte counts (ALC) of < 390 cells/μL or ALC after 3 months of CCRT (post3m-ALC) < 705 cells/μL was significantly associated with worse outcome than mini-ALC ≥ 390 cells/μL (OS, p=0.002; PFS, p=0.005; DMFS, p=0.004) or post3m-ALC ≥ 705 cells/μL (OS, p < 0.001; PFS, p < 0.001; DMFS, p=0.001). Patients with lymphopenia (mini-ALC < 390 cells/μL and post3m-ALC < 705 cells/μL) had a worse prognosis than those without lymphopenia (mini-ALC ≥ 390 cells/μL and post3m-ALC ≥ 705 cells/μL) (OS, p < 0.001; PFS, p < 0.001; DMFS, p < 0.001). Multivariate analysis revealed that post3m-ALC was an independent prognostic factor for OS (hazard ratio [HR], 1.76; 95% confidence interval [CI], 1.12 to 2.78; p=0.015), PFS (HR, 1.86; 95% CI, 1.23 to 2.82; p=0.003), and DMFS (HR, 1.87; 95% CI, 1.13 to 3.08; p=0.014). Multivariate analysis also revealed that patients with lymphopenia had a high risk of death (HR, 3.79; 95% CI, 1.75 to 8.19; p=0.001), disease progression (HR, 2.93; 95% CI, 1.59 to 5.41; p=0.001), and distant metastasis (HR, 3.89; 95% CI, 1.67 to 9.10; p=0.002). Multivariate analysis performed with time dependent Cox regression demonstrated ALC was an independent prognostic factor for OS (HR, 0.995; 95% CI, 0.991 to 0.999; p=0.025) and PFS (HR, 0.993; 95% CI, 0.988 to 0.998; p=0.006).
CONCLUSION
Treatment-related lymphopenia was a poor prognostic factor in NPC patients.

Keyword

Nasopharyngeal carcinoma; Lymphopenia; Survival; Radiotherapy

MeSH Terms

Chemoradiotherapy
Disease Progression
Disease-Free Survival
Humans
Lymphocyte Count
Lymphopenia*
Methods
Multivariate Analysis
Neoplasm Metastasis
Prognosis
Radiotherapy

Figure

• 

  Fig. 1. Variation in median ALC among all patients (A) and subgroups of patients stratified by the pre-ALC (< 1,315 cells/μL vs. ≥ 1,315 cells/μL) (B), mini-ALC (< 390 cells/μL vs. ≥ 390 cells/μL) (C), post-ALC (< 325 cells/μL vs. ≥ 325 cells/μL) (D), post3m-ALC (< 705 cells/μL vs. ≥ 705 cells/μL) (E), and mini-ALC combined with post3m-ALC (lymphopenia vs. nonlymphopenia) (F). ALC, absolute lymphocyte counts; pre-ALC, absolute lymphocyte counts before concurrent chemoradiotherapy; mini-ALC, minimum absolute lymphocyte counts during treatment; post-ALC, absolute lymphocyte counts after completion of treatment; post3m-ALC, absolute lymphocyte counts 3 months after completion of treatment.

• 

  Fig. 2. Comparison of patients in the lymphopenia group (mini-ALC < 390 cells/μL and post3m-ALC < 705 cells/μL) with patients in the non-lymphopenia group (mini-ALC ≥ 390 cells/μL or post3m-ALC ≥ 705 cells/μL) in terms of overall survival (A), progression-free survival (B), and distant metastasis-free survival (C). mini-ALC, minimum absolute lymphocyte counts during treatment; post3m-ALC, absolute lymphocyte counts 3 months after completion of treatment.

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