The Role of Lymphocyte Recovery Index in Prognosis Prediction for Locally Advanced Cervical Cancer With Radiation-Induced Lymphopenia

IF 3.1 2区医学 Q2 ONCOLOGY Cancer Medicine Pub Date : 2025-02-14 DOI:10.1002/cam4.70638

Yi Li, Ao Liu, Xin Wang, Longxiang Guo, Yuanlin Li, Defeng Liu, Xiuli Liu, Zhichao Li, Minghuan Li

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Abstract

Background

In patients with locally advanced cervical cancer (LACC) undergoing concurrent chemoradiotherapy (CCRT), the high incidence of radiation-induced lymphopenia significantly affects prognosis. There are significant variations in lymphocyte count (ALC) recovery patterns among patients, and their impact on prognosis remains unclear. This study aims to quantify the lymphocyte recovery patterns by the lymphocyte recovery index (LRI) and evaluate its prognostic value.

Methods

This study reviewed patients with LACC who had ALCs available within 6 months post-CCRT. Lymphopenia was graded using CTCAE 5.0, and lymphocyte recovery patterns were quantified using LRI (the ratio of ALCs at 6 months post-treatment to baseline ALCs). Cox regression analysis was conducted to assess the correlation between LRI, other clinical factors, and survival. The dose–volume of bone marrow (BM) following pelvic radiotherapy was collected, and measurements of spleen standardized uptake value (SUV) and spleen-to-liver SUVmax ratio (SLR) were obtained from pre-treatment 18F-FDG PET/CT. Logistic regression analysis was used to identify independent risk factors for LRI.

Results

A total of 180 patients were included retrospectively. During CCRT, 53 patients (29.4%) experienced G4 lymphopenia. The median LRI was 53.4% (range 13.2%–159.4%). Multivariable analysis revealed that LRI, G4 lymphopenia, and FIGO stage were associated with progression-free survival (PFS) and overall survival (OS). Subgroup analysis revealed that the degree of lymphopenia (G4 and G1-3) did not affect the correlation between LRI and PFS (P: 0.001 and 0.011) or OS (P: 0.003 and 0.043). Regarding FIGO stage, the impact of LRI on PFS (p < 0.001) and OS (p < 0.001) was primarily observed in patients with FIGO stage > II. Logistic analysis identified BM-V10 > 96.0% and SLR > 0.90 as independent risk factors for LRI.

Conclusion

In patients with LACC after CCRT, the LRI is associated with prognosis. Splenic metabolism and BM irradiation are associated with lymphocyte recovery.

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淋巴细胞恢复指数在局部晚期宫颈癌伴放射性淋巴细胞减少的预后预测中的作用

背景在局部晚期宫颈癌（LACC）同步放化疗（CCRT）患者中，放疗性淋巴细胞减少的高发显著影响预后。不同患者的淋巴细胞计数（ALC）恢复模式存在显著差异，其对预后的影响尚不清楚。本研究旨在通过淋巴细胞恢复指数（LRI）量化淋巴细胞恢复模式，并评价其预后价值。方法本研究回顾了在ccrt后6个月内有alc的LACC患者。使用CTCAE 5.0对淋巴细胞减少进行分级，使用LRI（治疗后6个月ALCs与基线ALCs的比值）量化淋巴细胞恢复模式。采用Cox回归分析评估LRI、其他临床因素与生存率的相关性。收集盆腔放疗后骨髓（BM）的剂量体积，并通过治疗前18F-FDG PET/CT测量脾脏标准化摄取值（SUV）和脾-肝SUVmax比（SLR）。采用Logistic回归分析确定LRI的独立危险因素。结果回顾性分析180例患者。CCRT期间53例（29.4%）出现G4淋巴细胞减少。中位LRI为53.4%（范围13.2%-159.4%）。多变量分析显示，LRI、G4淋巴细胞减少和FIGO分期与无进展生存期（PFS）和总生存期（OS）相关。亚组分析显示，淋巴细胞减少程度（G4和G1-3）不影响LRI与PFS （P: 0.001和0.011）或OS （P: 0.003和0.043）的相关性。FIGO分期方面，LRI对PFS （p < 0.001）和OS （p < 0.001）的影响主要见于FIGO分期II期患者。Logistic分析发现BM-V10 >； 96.0%和SLR >； 0.90是LRI的独立危险因素。结论CCRT后LACC患者，LRI与预后相关。脾代谢和BM照射与淋巴细胞恢复有关。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.