Lymphopenia Predicts Poor Prognosis in Patients With Esophageal Squamous Cell Carcinoma

Abstract

Lymphopenia is a useful predictive factor in several cancers. The aim of this study was to determine the prognostic value of lymphopenia in patients with esophageal squamous cell carcinoma (ESCC).A retrospective analysis of 307 consecutive patients who had undergone esophagectomy for ESCC was conducted. In our study, a lymphocyte count (LC) of fewer than 1.0 Giga/L was defined as lymphopenia. Kaplan–Meier method was used to calculate the cancer-specific survival (CSS). Cox regression analyses were performed to evaluate the prognostic factors. Receiver operating characteristic (ROC) curve was also plotted to verify the accuracy of LC for CSS prediction.The mean LC was 1.55 ± 0.64 Giga/L (range 0.4–3.7 Giga/L). The incidence of lymphopenia (LC < 1.0 Giga/L) was 16.6% (51/307). Patients with lymphopenia (LC < 1.0 Giga/L) had a significantly shorter 5-year CSS (21.6% vs 43.8%, P = 0.004). On multivariate analysis, lymphopenia (LC < 1.0 Giga/L) was an independent prognostic factor in patients with ESCC (P = 0.013). Lymphopenia had a hazard ratio (HR) of 1.579 [95% confidence interval (CI): 1.100–2.265] for CSS. ROC curve demonstrated that lymphopenia (LC < 1.0 Giga/L) predicts survival with a sensitivity of 86.2% and a specificity of 27.2%.Lymphopenia (LC < 1.0 Giga/L) is still an independent predictive factor for long-term survival in patients with ESCC.

Severe lymphopenia during neoadjuvant chemoradiation for esophageal cancer: A propensity matched analysis of the relative risk of proton versus photon-based radiation therapy

“…This relationship remained intact on multivariable analysis, adjusting for key patient demographic, treatment, and tumor characteristics, including PTV. Although few studies have evaluated the association between lymphopenia and patient outcomes in patients with esophageal cancer[15], several studies have also demonstrated a link between treatment-induced lymphopenia and inferior survival in glioblastoma[3], NSCLC[2, 7] and pancreatic cancer[1, 4]. Our study does also indicate an association between higher lymphocyte levels during treatment and better clinical outcomes in esophageal cancer.…”

Lymphocyte-Sparing Effect of Proton Therapy in Patients with Esophageal Cancer Treated with Definitive Chemoradiation

“…In other prior studies, lymphopenia has been associated with worse clinical outcomes in cancer treatment [1–9], likely through a combination of increased infection risk [17] and blunted antitumor immune-cell response [18–20]. …”

“…Lymphopenia during treatment for esophageal cancer [1–4] and other malignancies [5–9] is an independent predictor of worse clinical outcomes, including survival. Although chemoradiation (CRT) is the standard of care in the treatment of esophageal cancer [10], treatment-associated immunosuppression can occur to varying degree via mechanisms of direct lymphocyte depletion and blunting of lymphocyte responsiveness [11–14].…”

Prognostic value of inflammation-based scores in patients with osteosarcoma

“…Neutrophilia, thrombocytosis, monocytosis and lymphopenia tend to represent a nonspecific response to cancer-related inflammation and are associated with poor survival in cancers3233343536. Neutrophils interact with tumor cells by producing cytokines and chemokines, which affects tumor cells’ proliferation, angiogenesis, and metastases37.…”