Lymphopenia as a Potential Predictor of Ipsilateral Breast Tumor Recurrence in Early Breast Cancer

Abstract

Background/Aim: The aim of this study was to investigate the association between lymphopenia after breast conserving therapy (BCT) and ipsilateral breast tumor recurrence (IBTR) in early breast cancer (EBC). Patients and Methods: We examined 216 EBC patients treated with partial mastectomy followed by radiotherapy (RT), none of whom received chemotherapy. Absolute lymphocyte counts (ALCs) during the two years after RT were collected from each patient: pretreatment ALC, ALC at 3-5 months (ALC1), ALC at 9-11 months, ALC at 15-17 months, and ALC at 21-23 months. Results: The 102 patients with ALC1 ≤1,479 cells/μl (defined as lymphopenia) had significantly higher 10-year IBTR rate than the 102 patients with ALC1 >1,479 cells/μl (16.2% vs. 1%, p=0.0034). The multivariate analysis showed that age, resection margins, human epidermal growth factor receptor, and lymphopenia were significant predictors of IBTR. Conclusion: Lymphopenia is a potential predictor for IBTR in EBC patients treated with BCT.

Risk factors for radiation induced lymphopenia in patients with breast cancer receiving adjuvant radiotherapy

“…This is likely the first and the largest study examining risk factors for RIL in breast cancer patients, including radiation technique and dosimetric factors for lymphopenia and clinical significance. Our findings are consistent with the previous reports of several smaller studies (15,16). An early observational study of 34 patients by Stjernswärd et al in 1972 (18) reported long-term changes in PLC induced by RT in patients with breast cancer and their relation to tumor responses.…”

“…Our study of 735 patients demonstrated frequent RIL and heterogeneous reduction in lymphocytes after adjuvant radiotherapy. These findings have important clinical implications as a reduction in PLC is associated with immunosuppression, which significantly affects local control and survival in patients with breast cancer, as reported in several studies (6)(7)(8)15,16).…”

“…Emerging evidence showing radiation-induced lymphopenia (RIL) or PLC-related parameters are associated with poor survival outcomes in several solid tumors (9)(10)(11)(12)(13)(14). Cho et al reported RIL was a potential predictor for ipsilateral breast tumor recurrence in 216 patients with early breast cancer treated with breast-conserving therapy (BCT) (15). Most recently, a post hoc analysis of 598 patients from a phase III randomized clinical trial reported significantly inferior 5-year disease-free survival in patients with a nadir-PLC/pre-PLC ratio <0.8 in breast cancer patients treated with mastectomy followed by adjuvant RT (16).…”

<p>Predictive Value of Lymphocyte-Related Blood Parameters at the Time Point of Lymphocyte Nadir During Radiotherapy in Breast Cancer</p>

“…And in these research, time points of LRBP were artificial selection, and most of them were before or after radiotherapy. 11,12 It seemed that obtaining LRBP of all time points, once a week, during radiotherapy and then finding the most representative one to investigate and analyze was a better choice. As radiotherapy leads to lymphopenia, the lowest lymphocyte count during radiotherapy might better represent immune suppression state caused by radiotherapy than lymphocytes during other time points, so LRBP at the time point of lowest ALC during radiotherapy was chosen in our study, which was different from the previous research.…”

“…Among 221 patients, 49 (22.2%) patients reached DFS. The number of cases and the percentage of the metastatic and relapse sites were respectively: liver(11,22.4%), lymph gland(11,22.4%), chest wall (9, 18.4%), lung (9, 18.4%), bone (8, 16.3%), hydrothorax (3, 6.1%), and brain (2, 4.1%).…”