Lymphocyte Nadir and Esophageal Cancer Survival Outcomes After Chemoradiation Therapy

Rajayogesh Davuluri, Wen Jiang, Penny Fang, Cai Xu, Ritsuko Komaki, Daniel R. Gomez, James Welsh, James D. Cox, Christopher H. Crane, Charles C. Hsu, Steven H. Lin

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)128-135
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume99
Issue number1
DOIs
StatePublished - Sep 1 2017
Externally publishedYes

Fingerprint

lymphocytes
Esophageal Neoplasms
therapy
Lymphocyte Count
cancer
grade
Lymphocytes
Survival
immunity
Immunity
Therapeutics
Radiation
radiation
monocytes
neutrophils
terminology
Lymphopenia
chemotherapy
predictions
hazards

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Lymphocyte Nadir and Esophageal Cancer Survival Outcomes After Chemoradiation Therapy. / Davuluri, Rajayogesh; Jiang, Wen; Fang, Penny; Xu, Cai; Komaki, Ritsuko; Gomez, Daniel R.; Welsh, James; Cox, James D.; Crane, Christopher H.; Hsu, Charles C.; Lin, Steven H.

In: International Journal of Radiation Oncology Biology Physics, Vol. 99, No. 1, 01.09.2017, p. 128-135.

Research output: Contribution to journalArticle

Davuluri, R, Jiang, W, Fang, P, Xu, C, Komaki, R, Gomez, DR, Welsh, J, Cox, JD, Crane, CH, Hsu, CC & Lin, SH 2017, 'Lymphocyte Nadir and Esophageal Cancer Survival Outcomes After Chemoradiation Therapy', International Journal of Radiation Oncology Biology Physics, vol. 99, no. 1, pp. 128-135. https://doi.org/10.1016/j.ijrobp.2017.05.037
Davuluri, Rajayogesh ; Jiang, Wen ; Fang, Penny ; Xu, Cai ; Komaki, Ritsuko ; Gomez, Daniel R. ; Welsh, James ; Cox, James D. ; Crane, Christopher H. ; Hsu, Charles C. ; Lin, Steven H. / Lymphocyte Nadir and Esophageal Cancer Survival Outcomes After Chemoradiation Therapy. In: International Journal of Radiation Oncology Biology Physics. 2017 ; Vol. 99, No. 1. pp. 128-135.
@article{c7ee3b023a974c86bbb710ce02042dfe,
title = "Lymphocyte Nadir and Esophageal Cancer Survival Outcomes After Chemoradiation Therapy",
abstract = "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.",
author = "Rajayogesh Davuluri and Wen Jiang and Penny Fang and Cai Xu and Ritsuko Komaki and Gomez, {Daniel R.} and James Welsh and Cox, {James D.} and Crane, {Christopher H.} and Hsu, {Charles C.} and Lin, {Steven H.}",
year = "2017",
month = "9",
day = "1",
doi = "10.1016/j.ijrobp.2017.05.037",
language = "English (US)",
volume = "99",
pages = "128--135",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - Lymphocyte Nadir and Esophageal Cancer Survival Outcomes After Chemoradiation Therapy

AU - Davuluri, Rajayogesh

AU - Jiang, Wen

AU - Fang, Penny

AU - Xu, Cai

AU - Komaki, Ritsuko

AU - Gomez, Daniel R.

AU - Welsh, James

AU - Cox, James D.

AU - Crane, Christopher H.

AU - Hsu, Charles C.

AU - Lin, Steven H.

PY - 2017/9/1

Y1 - 2017/9/1

N2 - 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.

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.

UR - http://www.scopus.com/inward/record.url?scp=85027698628&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85027698628&partnerID=8YFLogxK

U2 - 10.1016/j.ijrobp.2017.05.037

DO - 10.1016/j.ijrobp.2017.05.037

M3 - Article

C2 - 28816138

AN - SCOPUS:85027698628

VL - 99

SP - 128

EP - 135

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 1

ER -