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

58 Scopus citations

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

ASJC Scopus subject areas

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

Fingerprint Dive into the research topics of 'Lymphocyte Nadir and Esophageal Cancer Survival Outcomes After Chemoradiation Therapy'. Together they form a unique fingerprint.

  • Cite this

    Davuluri, R., Jiang, W., Fang, P., Xu, C., Komaki, R., Gomez, D. R., Welsh, J., Cox, J. D., Crane, C. H., Hsu, C. C., & Lin, S. H. (2017). Lymphocyte Nadir and Esophageal Cancer Survival Outcomes After Chemoradiation Therapy. International Journal of Radiation Oncology Biology Physics, 99(1), 128-135. https://doi.org/10.1016/j.ijrobp.2017.05.037