食管癌放疗患者淋巴细胞最低值与疗效和预后的关系

Relationship Between Lymphocyte Nadir and Radiotherapy Efficacy or Prognosis of Patients with Esophageal Carcinoma

目的评价食管癌在放疗期间淋巴细胞抑制与近期疗效及预后的关系。方法回顾性分析2011年1月至2012年12月在徐州中心医院接受根治性放疗的112例食管癌患者,记录从放疗开始至放疗结束1年期间内淋巴细胞计数。卡方检验分析临床病理资料及近期疗效与放疗期间淋巴细胞最低值的关系。采用单因素及多因素Cox回归模型分析淋巴细胞最低值与预后的关系。结果全组患者放疗前淋巴细胞计数为(1.78±0.76)个/毫米3,放疗过程中淋巴细胞计数最低值为(0.45±0.22)个/毫米3,放疗结束1年淋巴细胞计数为(1.15±0.39)个/毫米3。食管癌病变长度、病变最大宽度及是否行同期化疗是影响放疗期间淋巴细胞降低的因素(P<0.05)。放疗期间淋巴细胞最低值≥0.5个/毫米3组与<0.5个/毫米3组近期有效率分别为92%与70%(χ2=7.66,P=0.007)。生存分析显示淋巴细胞最低值<0.5个/毫米3组生存低于≥0.5个/毫米3组(χ2=4.489,P=0.034),两组1年及2年生存率分别为51.6%、37.4%及81.3%、54.0%。单因素及多因素Cox回归分析均显示,TNM分期、病变长度及淋巴细胞最低值是影响生存的独立因素。结论患者放疗期间淋巴细胞计数最低值作为一种经济、简便的检测指标,可有效预测根治性放疗食管癌患者的近期疗效及远期预后。

Objective To evaluate the predictive value of radiation-induced lymphopenia in short-term effect and prognosis of patients with esophageal carcinoma who received radiotherapy(RT). Methods We retrospectively analyzed clinicopathologic data of 112 patients undergoing radical intent RT in Xuzhou Gentral Hospital from Jan.2011 to Dec. 2012. Total lymphocyte counts were collected from the beginning to the end of RT for one year. The relationship between lymphocyte nadirs and clinicopathologic data, shortterm effect were assessed with Chi-squared test. Univariate and multivariate Cox analysis were used to assess the association between lymphocyte nadir and overall survival(OS). Results The total lymphocyte count for all patients before RT was(1.78±0.76) cells/mm3. The lymphocyte nadir during RT and the total lymphocyte count at one year after RT were(0.45±0.22) and(1.15±0.39) cells/mm3, respectively. Tumor length, maximum tumor width, and receipt of concurrent chemotherapy were influential factors for radiationinduced lymphopenia(all P<0.05). The response rate for patients with high and low lymphocyte nadir(≥and <0.5 cells/mm3) were 92% and 70%, respectively(χ2=7.66, P=0.007). The 1- and 2-year survival rates of patients with low lymphocyte nadir were significantly worse than that of high lymphocyte nadir groups(51.6%, 37.4% vs. 81.3%, 54.0%, χ2= 4.489, P=0.034). Both univariate and multivariate analysis revealed that TNM stage, tumor length and lymphocyte nadirs were independent factors for OS. Conclusion Lymphocyte nadir during RT, as an inexpensive and convenient marker, could predict short-term effect and provide prognostic values for esophageal carcinoma patients who received radical RT.