{"title":"Treatment-Related Lymphopenia is Possibly a Marker of Good Prognosis in Nasopharyngeal Carcinoma: a Propensity-Score Matching Analysis","authors":"Ke-gui Weng, Hai-ke Lei, De-Song Shen, Ying Wang, Xiao-Dong Zhu","doi":"10.2147/cmar.s456717","DOIUrl":null,"url":null,"abstract":"<strong>Purpose:</strong> The aims of the study were to monitor circulating lymphocyte subset counts before and after therapy for nasopharyngeal carcinoma (NPC), and investigate their relationships with patient outcomes.<br/><strong>Patients and Methods:</strong> Subjects comprised patients with TNM stage I–IVA NPC who underwent radiotherapy. Peripheral venous blood samples were collected before and after treatment. Lymphocyte subset counts were analyzed by flow cytometry. Differences between post-treatment and baseline counts were calculated to determine Δ values. Patients were divided into high and low groups, based on median lymphocyte subset counts; propensity score matching was applied to balance groups. Progression-free survival (PFS) and overall survival (OS) were plotted using Kaplan-Meier curves and compared using a Log rank test. Relationships between lymphocyte subset counts and patient survival were subjected to Cox regression analysis.<br/><strong>Results:</strong> Patients with NPC (n=746) were enrolled from 2012– 2022. Higher CD8<sup>+</sup> and total T cell baseline counts were associated with better 5-year PFS (73.7% vs 63.1%, P=0.002 and 73.8% vs 64.1%, P=0.005, respectively). Similarly, higher Δ values of CD4<sup>+</sup> and total T cells were associated with higher 5-year PFS (76.2% vs 63.5%, P=0.001; 74.3% vs 65.4%, P=0.010) and OS (89.8% vs 81.6%, P=0.005; 88.6% vs 82.5%, P=0.009). Multivariate Cox regression revealed that CD8<sup>+</sup> (hazard ratio (HR) 0.651, P=0.002) and total T (HR 0.600, P< 0.001) cells were significantly associated with PFS. CD4<sup>+</sup> (HR 0.708, P=0.038) and total T (HR 0.639, P=0.031) cells were independent prognostic factors for OS.<br/><strong>Conclusion:</strong> NPC patients with low total or CD8<sup>+</sup> T cell counts before treatment had worse prognosis; however, those with more significant decreases in total or CD4<sup>+</sup> T cells possibly had better outcomes. T cell counts can be reliable indicators to predict prognosis.<br/><br/><strong>Keywords:</strong> chemoradiotherapy, T cell counts, progression-free survival, overall survival, propensity score matching<br/>","PeriodicalId":9479,"journal":{"name":"Cancer Management and Research","volume":null,"pages":null},"PeriodicalIF":2.5000,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancer Management and Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/cmar.s456717","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: The aims of the study were to monitor circulating lymphocyte subset counts before and after therapy for nasopharyngeal carcinoma (NPC), and investigate their relationships with patient outcomes. Patients and Methods: Subjects comprised patients with TNM stage I–IVA NPC who underwent radiotherapy. Peripheral venous blood samples were collected before and after treatment. Lymphocyte subset counts were analyzed by flow cytometry. Differences between post-treatment and baseline counts were calculated to determine Δ values. Patients were divided into high and low groups, based on median lymphocyte subset counts; propensity score matching was applied to balance groups. Progression-free survival (PFS) and overall survival (OS) were plotted using Kaplan-Meier curves and compared using a Log rank test. Relationships between lymphocyte subset counts and patient survival were subjected to Cox regression analysis. Results: Patients with NPC (n=746) were enrolled from 2012– 2022. Higher CD8+ and total T cell baseline counts were associated with better 5-year PFS (73.7% vs 63.1%, P=0.002 and 73.8% vs 64.1%, P=0.005, respectively). Similarly, higher Δ values of CD4+ and total T cells were associated with higher 5-year PFS (76.2% vs 63.5%, P=0.001; 74.3% vs 65.4%, P=0.010) and OS (89.8% vs 81.6%, P=0.005; 88.6% vs 82.5%, P=0.009). Multivariate Cox regression revealed that CD8+ (hazard ratio (HR) 0.651, P=0.002) and total T (HR 0.600, P< 0.001) cells were significantly associated with PFS. CD4+ (HR 0.708, P=0.038) and total T (HR 0.639, P=0.031) cells were independent prognostic factors for OS. Conclusion: NPC patients with low total or CD8+ T cell counts before treatment had worse prognosis; however, those with more significant decreases in total or CD4+ T cells possibly had better outcomes. T cell counts can be reliable indicators to predict prognosis.
目的：该研究旨在监测鼻咽癌（NPC）治疗前后的循环淋巴细胞亚群计数，并研究其与患者预后的关系：研究对象包括接受放疗的 TNM I-IVA 期鼻咽癌患者。在治疗前后采集外周静脉血样本。用流式细胞术分析淋巴细胞亚群计数。计算治疗后计数与基线计数的差异，以确定Δ值。根据淋巴细胞亚群计数中位数将患者分为高、低两组，并采用倾向得分匹配法来平衡各组。采用 Kaplan-Meier 曲线绘制无进展生存期（PFS）和总生存期（OS），并采用对数秩检验进行比较。淋巴细胞亚群计数与患者生存率之间的关系采用 Cox 回归分析：从2012年到2022年，共招募了746名鼻咽癌患者。较高的CD8+和总T细胞基线计数与较好的5年PFS相关（分别为73.7% vs 63.1%，P=0.002和73.8% vs 64.1%，P=0.005）。同样，CD4+和总T细胞的Δ值越高，5年PFS（76.2% vs 63.5%，P=0.001；74.3% vs 65.4%，P=0.010）和OS（89.8% vs 81.6%，P=0.005；88.6% vs 82.5%，P=0.009）越高。多变量考克斯回归显示，CD8+（危险比（HR）0.651，P=0.002）和总T细胞（HR 0.600，P< 0.001）与PFS显著相关。CD4+细胞（HR 0.708，P=0.038）和总T细胞（HR 0.639，P=0.031）是OS的独立预后因素：结论：治疗前总T细胞数或CD8+T细胞数较低的鼻咽癌患者预后较差；但总T细胞数或CD4+T细胞数下降较明显的患者预后可能较好。T细胞计数可以作为预测预后的可靠指标。关键词：化放疗；T细胞计数；无进展生存期；总生存期；倾向评分匹配
期刊介绍：
Cancer Management and Research is an international, peer reviewed, open access journal focusing on cancer research and the optimal use of preventative and integrated treatment interventions to achieve improved outcomes, enhanced survival, and quality of life for cancer patients. Specific topics covered in the journal include:
◦Epidemiology, detection and screening
◦Cellular research and biomarkers
◦Identification of biotargets and agents with novel mechanisms of action
◦Optimal clinical use of existing anticancer agents, including combination therapies
◦Radiation and surgery
◦Palliative care
◦Patient adherence, quality of life, satisfaction
The journal welcomes submitted papers covering original research, basic science, clinical & epidemiological studies, reviews & evaluations, guidelines, expert opinion and commentary, and case series that shed novel insights on a disease or disease subtype.
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