Prognostic value of absolute lymphocyte count in patients with advanced esophageal cancer treated with immunotherapy: a retrospective analysis

Abstract

Background: Immunotherapy has become the standard of treatment for recurrent metastatic esophageal cancer (EC), and the value of efficacy predictive markers represented by programmed death-ligand 1 (PD-L1) is limited. The purpose of this study is to analyze the prognostic value of peripheral blood absolute lymphocyte count (ALC) at baseline in patients with recurrent metastatic EC treated with immunotherapy, and to further investigate the relationship between the minimal ALC value (Min ALC) and radiotherapy (RT) parameters. Methods:The main inclusion criteria were: histologically or imaging confirmed recurrent or metastatic EC; complete routine blood test data. A total of 105 patients were included in a single-center institution, 65 of whom had previously received RT. The optimal cut-off value for baseline lymphopenia was determined by the receiver operating characteristic (ROC) curve. The prognostic value of baseline phase lymphopenia for immunotherapy were determined by cox regression analysis and the associated factors affecting lymphopenia were explored by logistic regression analysis. Results:The cut-off value for baseline ALC predicting 1-year overall survival (OS) was 625 cells/μL. The OS was significantly lower in the lymphopenia group (ALC ≤625 cells/μL) than in the non-lymphopenia group (ALC >625 cells/μL) (median OS: 6 vs. 12 months, P=0.002). Multivariate analysis showed that preimmunotherapy lymphopenia was an important factor influencing patient prognosis [hazard ratio (HR): 1.771, 95% confidence interval (CI): 1.051-2.985; P=0.032)] (adjusted for clinical factors including sex, age, tumor location, histology, degree of differentiation, distant metastasis, use of RT). Patients with a previous grade 4 (G4) Min ALC during RT were more likely to develop pre-immunotherapy lymphopenia following diagnosis of recurrent metastasis [odds ratio (OR): 10.809, 95% CI: 2.185-53.471; P=0.004]. Planning target volume (PTV) volume greater than 521.2 cm 3 (OR: 19.981, 95% CI: 1.372-290.985; P=0.028) was an independent risk factor affecting the G4 Min ALC during RT.Conclusions: Lymphopenia is associated with a poorer immunotherapy prognosis in patients with recurrent metastatic EC and those with previous G4 Min ALC after RT. RT-related parameters, especially irradiation volume, can significantly affect lymphocyte counts.

Prognostic value of the advanced lung cancer inflammation index in patients with gastric cancer after radical gastrectomy: a propensity-score matching cohort study and meta-analysis

“…Conversely, a decrease in lymphocyte counts hampers the immune response against cancer cells [ 38 ]. The presence of lymphopenia has been shown to be correlated with an unfavorable prognosis in individuals diagnosed with cancer [ 39 ]. Consequently, the ALI, in conjunction with these factors, serves as a valuable comprehensive indicator of nutritional and inflammatory status, facilitating a deeper comprehension of patients’ functional state and offering predictive insights into survival outcomes for individuals with gastric cancer.…”

Prognostic Value of Absolute Lymphocyte Count in Patients with Advanced Renal Cell Carcinoma Treated with Nivolumab Plus Ipilimumab

“…Furthermore, ALC represents the state of immune function in the patient, and lymphopenia may be associated with a poor prognosis in patients receiving ICIs. Low ALC before ICI initiation is a predictor of poor response in many cancers, including lung cancer, esophageal cancer, head and neck cancer, and melanoma [ 11 , 12 , 22 , 23 , 24 ]. We previously reported that ALC was an independent biomarker of therapeutic response in patients with metastatic RCC treated with nivolumab monotherapy [ 10 ].…”

Clinical significance of the advanced lung cancer inflammation index in gastrointestinal cancer patients: a systematic review and meta-analysis

“…While lymphocytes, especially CD4+ T lymphocytes and CD8+ T lymphocytes, as the most important immune cells, play an anti-tumor role by inducing the lysis and apoptosis of tumor cells ( 41 ). Lymphopenia has been demonstrated to be associated with poor prognosis in cancer patients ( 42 , 43 ). On the other hand, nutritional status is also reported as an important predictive factor of therapeutic outcomes in several types of malignancies ( 44 , 45 ).…”