High lymphocyte count during neoadjuvant chemoradiotherapy is associated with improved pathologic complete response in esophageal cancer

Penny Fang, Wen Jiang, Rajayogesh Davuluri, Cai Xu, Sunil Krishnan, Radhe Mohan, Albert C. Koong, Charles C. Hsu, Steven H. Lin

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background and purpose: Neoadjuvant chemoradiation (nCRT) can reduce tumor infiltrating lymphocytes. We examined absolute lymphocyte count (ALC) nadir during nCRT for esophageal cancer (EC) and pathologic complete response (pCR). Materials and methods: Patients with stage I–IVA EC (n = 313) treated 2007–2013 with nCRT followed by surgery were analyzed. ALC was obtained before, during/weekly, and one month after CRT. pCR was defined as no viable tumor cells at surgery. High ALC was defined as nadir of ≥0.35 × 103/μL (highest tertile). Comparison of continuous and categorical variables by pCR was assessed by ANOVA and Pearson's chi-square. Univariate/multivariate logistic regression was used to assess predictors of pCR and high ALC nadir. Results: Eighty-nine patients (27.8%) achieved a complete pathological response (pCR). For patients with pCR, median ALC nadir was significantly higher than those without (0.35 × 103/μL vs 0.29 × 103/μL, p = 0.007). Patients maintaining high ALC nadir had a higher pCR rate (OR1.82, 95%CI 1.08–3.05, p = 0.024). Predictors of high ALC included treatment with proton therapy vs. IMRT (OR4.18, 95%CI 2.34–7.47, p < 0.001), smoking at diagnosis (OR2.80, 95%CI 1.49–5.25, p = 0.001), early stage I–II disease (OR2.33, 95%CI 1.32–4.17, p = 0.005), and SCC histology (OR3.70, 95%CI 1.01–14.29, p = 0.048). Mean body dose (MBD) was inversely related to high ALC nadir (OR0.77 per Gy, 95%CI 0.70–0.84, p < 0.001). Conclusion: A higher ALC level during nCRT is associated with a higher rate of pCR for esophageal cancer patients undergoing trimodality therapy.

Original languageEnglish (US)
Pages (from-to)584-590
Number of pages7
JournalRadiotherapy and Oncology
Volume128
Issue number3
DOIs
StatePublished - Sep 2018
Externally publishedYes

Fingerprint

Lymphocyte Count
Chemoradiotherapy
Esophageal Neoplasms
Proton Therapy
Tumor-Infiltrating Lymphocytes
Histology
Analysis of Variance
Logistic Models
Smoking
Therapeutics

Keywords

  • Absolute lymphocyte count
  • Chemoradiation
  • Esophageal cancer
  • Lymphopenia
  • Neoadjuvant
  • Pathologic response

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

High lymphocyte count during neoadjuvant chemoradiotherapy is associated with improved pathologic complete response in esophageal cancer. / Fang, Penny; Jiang, Wen; Davuluri, Rajayogesh; Xu, Cai; Krishnan, Sunil; Mohan, Radhe; Koong, Albert C.; Hsu, Charles C.; Lin, Steven H.

In: Radiotherapy and Oncology, Vol. 128, No. 3, 09.2018, p. 584-590.

Research output: Contribution to journalArticle

Fang, Penny ; Jiang, Wen ; Davuluri, Rajayogesh ; Xu, Cai ; Krishnan, Sunil ; Mohan, Radhe ; Koong, Albert C. ; Hsu, Charles C. ; Lin, Steven H. / High lymphocyte count during neoadjuvant chemoradiotherapy is associated with improved pathologic complete response in esophageal cancer. In: Radiotherapy and Oncology. 2018 ; Vol. 128, No. 3. pp. 584-590.
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abstract = "Background and purpose: Neoadjuvant chemoradiation (nCRT) can reduce tumor infiltrating lymphocytes. We examined absolute lymphocyte count (ALC) nadir during nCRT for esophageal cancer (EC) and pathologic complete response (pCR). Materials and methods: Patients with stage I–IVA EC (n = 313) treated 2007–2013 with nCRT followed by surgery were analyzed. ALC was obtained before, during/weekly, and one month after CRT. pCR was defined as no viable tumor cells at surgery. High ALC was defined as nadir of ≥0.35 × 103/μL (highest tertile). Comparison of continuous and categorical variables by pCR was assessed by ANOVA and Pearson's chi-square. Univariate/multivariate logistic regression was used to assess predictors of pCR and high ALC nadir. Results: Eighty-nine patients (27.8{\%}) achieved a complete pathological response (pCR). For patients with pCR, median ALC nadir was significantly higher than those without (0.35 × 103/μL vs 0.29 × 103/μL, p = 0.007). Patients maintaining high ALC nadir had a higher pCR rate (OR1.82, 95{\%}CI 1.08–3.05, p = 0.024). Predictors of high ALC included treatment with proton therapy vs. IMRT (OR4.18, 95{\%}CI 2.34–7.47, p < 0.001), smoking at diagnosis (OR2.80, 95{\%}CI 1.49–5.25, p = 0.001), early stage I–II disease (OR2.33, 95{\%}CI 1.32–4.17, p = 0.005), and SCC histology (OR3.70, 95{\%}CI 1.01–14.29, p = 0.048). Mean body dose (MBD) was inversely related to high ALC nadir (OR0.77 per Gy, 95{\%}CI 0.70–0.84, p < 0.001). Conclusion: A higher ALC level during nCRT is associated with a higher rate of pCR for esophageal cancer patients undergoing trimodality therapy.",
keywords = "Absolute lymphocyte count, Chemoradiation, Esophageal cancer, Lymphopenia, Neoadjuvant, Pathologic response",
author = "Penny Fang and Wen Jiang and Rajayogesh Davuluri and Cai Xu and Sunil Krishnan and Radhe Mohan and Koong, {Albert C.} and Hsu, {Charles C.} and Lin, {Steven H.}",
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T1 - High lymphocyte count during neoadjuvant chemoradiotherapy is associated with improved pathologic complete response in esophageal cancer

AU - Fang, Penny

AU - Jiang, Wen

AU - Davuluri, Rajayogesh

AU - Xu, Cai

AU - Krishnan, Sunil

AU - Mohan, Radhe

AU - Koong, Albert C.

AU - Hsu, Charles C.

AU - Lin, Steven H.

PY - 2018/9

Y1 - 2018/9

N2 - Background and purpose: Neoadjuvant chemoradiation (nCRT) can reduce tumor infiltrating lymphocytes. We examined absolute lymphocyte count (ALC) nadir during nCRT for esophageal cancer (EC) and pathologic complete response (pCR). Materials and methods: Patients with stage I–IVA EC (n = 313) treated 2007–2013 with nCRT followed by surgery were analyzed. ALC was obtained before, during/weekly, and one month after CRT. pCR was defined as no viable tumor cells at surgery. High ALC was defined as nadir of ≥0.35 × 103/μL (highest tertile). Comparison of continuous and categorical variables by pCR was assessed by ANOVA and Pearson's chi-square. Univariate/multivariate logistic regression was used to assess predictors of pCR and high ALC nadir. Results: Eighty-nine patients (27.8%) achieved a complete pathological response (pCR). For patients with pCR, median ALC nadir was significantly higher than those without (0.35 × 103/μL vs 0.29 × 103/μL, p = 0.007). Patients maintaining high ALC nadir had a higher pCR rate (OR1.82, 95%CI 1.08–3.05, p = 0.024). Predictors of high ALC included treatment with proton therapy vs. IMRT (OR4.18, 95%CI 2.34–7.47, p < 0.001), smoking at diagnosis (OR2.80, 95%CI 1.49–5.25, p = 0.001), early stage I–II disease (OR2.33, 95%CI 1.32–4.17, p = 0.005), and SCC histology (OR3.70, 95%CI 1.01–14.29, p = 0.048). Mean body dose (MBD) was inversely related to high ALC nadir (OR0.77 per Gy, 95%CI 0.70–0.84, p < 0.001). Conclusion: A higher ALC level during nCRT is associated with a higher rate of pCR for esophageal cancer patients undergoing trimodality therapy.

AB - Background and purpose: Neoadjuvant chemoradiation (nCRT) can reduce tumor infiltrating lymphocytes. We examined absolute lymphocyte count (ALC) nadir during nCRT for esophageal cancer (EC) and pathologic complete response (pCR). Materials and methods: Patients with stage I–IVA EC (n = 313) treated 2007–2013 with nCRT followed by surgery were analyzed. ALC was obtained before, during/weekly, and one month after CRT. pCR was defined as no viable tumor cells at surgery. High ALC was defined as nadir of ≥0.35 × 103/μL (highest tertile). Comparison of continuous and categorical variables by pCR was assessed by ANOVA and Pearson's chi-square. Univariate/multivariate logistic regression was used to assess predictors of pCR and high ALC nadir. Results: Eighty-nine patients (27.8%) achieved a complete pathological response (pCR). For patients with pCR, median ALC nadir was significantly higher than those without (0.35 × 103/μL vs 0.29 × 103/μL, p = 0.007). Patients maintaining high ALC nadir had a higher pCR rate (OR1.82, 95%CI 1.08–3.05, p = 0.024). Predictors of high ALC included treatment with proton therapy vs. IMRT (OR4.18, 95%CI 2.34–7.47, p < 0.001), smoking at diagnosis (OR2.80, 95%CI 1.49–5.25, p = 0.001), early stage I–II disease (OR2.33, 95%CI 1.32–4.17, p = 0.005), and SCC histology (OR3.70, 95%CI 1.01–14.29, p = 0.048). Mean body dose (MBD) was inversely related to high ALC nadir (OR0.77 per Gy, 95%CI 0.70–0.84, p < 0.001). Conclusion: A higher ALC level during nCRT is associated with a higher rate of pCR for esophageal cancer patients undergoing trimodality therapy.

KW - Absolute lymphocyte count

KW - Chemoradiation

KW - Esophageal cancer

KW - Lymphopenia

KW - Neoadjuvant

KW - Pathologic response

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