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Lymphocyte Nadir and Esophageal Cancer Survival Outcomes After Chemoradiation Therapy.

Abstract Host immunity may affect the outcome in patients with esophageal cancer. We sought to identify factors that influenced absolute lymphocyte count (ALC) nadir during chemoradiation therapy (CRT) for esophageal cancer (EC) and looked for clinically relevant associations with survival.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title international journal of radiation oncology, biology, physics
Publication Year Start




PMID- 28816138
OWN - NLM
STAT- MEDLINE
DA  - 20170817
DCOM- 20170821
LR  - 20170821
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 99
IP  - 1
DP  - 2017 Sep 01
TI  - Lymphocyte Nadir and Esophageal Cancer Survival Outcomes After Chemoradiation
      Therapy.
PG  - 128-135
LID - S0360-3016(17)30975-6 [pii]
LID - 10.1016/j.ijrobp.2017.05.037 [doi]
AB  - PURPOSE: Host immunity may affect the outcome in patients with esophageal cancer.
      We sought to identify factors that influenced absolute lymphocyte count (ALC)
      nadir during chemoradiation therapy (CRT) for esophageal cancer (EC) and looked
      for clinically relevant associations with survival. METHODS AND MATERIALS: 504
      patients with stage I-III EC (2007-2013) treated with neoadjuvant or definitive
      CRT with weekly ALC determinations made during treatment were analyzed. Grade of 
      lymphopenia from ALC nadir during CRT was based on Common Terminology Criteria
      for Adverse Events version 4.0. Associations of ALC nadir with survival were
      examined using multivariate Cox proportional hazards analysis (MVA) and competing
      risks regression analysis. RESULTS: The median follow-up time was 36 months. The 
      incidences of grade 1, 2, 3, and 4 ALC nadir during CRT were 2%, 12%, 59%, and
      27%, respectively. The impact was lymphocyte-specific because this was not seen
      for monocyte or neutrophil count. On MVA, grade 4 ALC nadir (G4 nadir) was
      significantly associated with worse overall and disease-specific survival
      outcomes. Predictors of G4 nadir included distal tumor location, definitive CRT, 
      taxane/5-fluorouracil chemotherapy, and photon-based radiation type (vs
      proton-based). Radiation type strongly influenced the mean body dose exposure,
      which was a strong predictor for G4 nadir (odds ratio 1.22 per Gray, P<.001).
      CONCLUSIONS: G4 nadir during CRT for EC was associated with poor outcomes,
      suggesting a role of host immunity in disease control. This observation provides 
      a rationale to prospectively test chemotherapeutic and radiation treatment
      strategies that may have a lower impact on host immunity.
CI  - Copyright (c) 2017 Elsevier Inc. All rights reserved.
FAU - Davuluri, Rajayogesh
AU  - Davuluri R
AD  - Department of Radiation Oncology, The University of Arizona, Tucson, Arizona.
FAU - Jiang, Wen
AU  - Jiang W
AD  - Department of Radiation Oncology, The University of Texas MD Anderson Cancer
      Center, Houston, Texas.
FAU - Fang, Penny
AU  - Fang P
AD  - Department of Radiation Oncology, The University of Texas MD Anderson Cancer
      Center, Houston, Texas.
FAU - Xu, Cai
AU  - Xu C
AD  - Department of Radiation Oncology, The University of Texas MD Anderson Cancer
      Center, Houston, Texas.
FAU - Komaki, Ritsuko
AU  - Komaki R
AD  - Department of Radiation Oncology, The University of Texas MD Anderson Cancer
      Center, Houston, Texas.
FAU - Gomez, Daniel R
AU  - Gomez DR
AD  - Department of Radiation Oncology, The University of Texas MD Anderson Cancer
      Center, Houston, Texas.
FAU - Welsh, James
AU  - Welsh J
AD  - Department of Radiation Oncology, The University of Texas MD Anderson Cancer
      Center, Houston, Texas.
FAU - Cox, James D
AU  - Cox JD
AD  - Department of Radiation Oncology, The University of Texas MD Anderson Cancer
      Center, Houston, Texas.
FAU - Crane, Christopher H
AU  - Crane CH
AD  - Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New
      York, New York.
FAU - Hsu, Charles C
AU  - Hsu CC
AD  - Department of Radiation Oncology, The University of Arizona, Tucson, Arizona.
FAU - Lin, Steven H
AU  - Lin SH
AD  - Department of Radiation Oncology, The University of Texas MD Anderson Cancer
      Center, Houston, Texas. Electronic address: [email protected]
LA  - eng
PT  - Journal Article
DEP - 20170601
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
RN  - 0 (Platinum Compounds)
RN  - 0 (Taxoids)
RN  - U3P01618RT (Fluorouracil)
SB  - IM
MH  - Adenocarcinoma/immunology/*mortality/pathology/*therapy
MH  - Carcinoma, Squamous Cell/immunology/*mortality/pathology/*therapy
MH  - Chemoradiotherapy/*adverse effects/methods
MH  - Esophageal Neoplasms/immunology/*mortality/pathology/*therapy
MH  - Fluorouracil/therapeutic use
MH  - Humans
MH  - Incidence
MH  - Kaplan-Meier Estimate
MH  - Lymphocyte Count
MH  - Lymphopenia/epidemiology/etiology/*mortality
MH  - Middle Aged
MH  - Monocytes/drug effects/radiation effects
MH  - Neutrophils/drug effects/radiation effects
MH  - Odds Ratio
MH  - Platinum Compounds/therapeutic use
MH  - Proportional Hazards Models
MH  - Proton Therapy
MH  - Radiotherapy Dosage
MH  - Regression Analysis
MH  - Retrospective Studies
MH  - T-Lymphocytes/drug effects/radiation effects
MH  - Taxoids/therapeutic use
MH  - Treatment Outcome
EDAT- 2017/08/18 06:00
MHDA- 2017/08/22 06:00
CRDT- 2017/08/18 06:00
PHST- 2017/02/05 [received]
PHST- 2017/05/12 [revised]
PHST- 2017/05/22 [accepted]
AID - S0360-3016(17)30975-6 [pii]
AID - 10.1016/j.ijrobp.2017.05.037 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2017 Sep 1;99(1):128-135. doi:
      10.1016/j.ijrobp.2017.05.037. Epub 2017 Jun 1.