Abstract
BackgroundSevere lymphopenia during treatment is considered to be a poor prognostic factor. The current literature lacks information regarding its impact on various outcomes in locally advanced head-and-neck cancer patients in a prospective setting.MethodsWe recently published a randomised study comparing cisplatin–radiation with nimotuzumab cisplatin–radiation. The database of this study was used for the present analysis. The impact of severe lymphopenia (grade 4 lymphopenia) on progression-free survival (PFS), locoregional control (LRC) and overall survival (OS) was studied using the Kaplan–Meier method and Cox regression analysis. The binary logistic regression analysis was used to see the effect of various factors on the development of severe lymphopenia.ResultsWe had a total of 536 patients, of which 521 patients (97.7%) developed lymphopenia. Grade 1 lymphopenia was noted in 10 (1.9%) patients, grade 2 in 100 (18.8%), grade 3 in 338 (63.1%) and grade 4 in 73 (13.7%) patients. The median PFS was 20.53 and 60.33 months in severe and non-severe lymphopenia, respectively (hazard ratio, 0.797; p-value = 0.208). The median duration of LRC was 56.3 months in severe lymphopenia, whereas it was not reached in non-severe lymphopenia (hazard ratio, 0.81; p-value = 0.337). The median OS was 28.46 versus 47.13 months in severe and non-severe lymphopenia, respectively (hazard ratio, 0.76; p-value = 0.11). Of various risk factors, gender was significantly associated with severe lymphopenia.ConclusionThe occurrence of severe lymphopenia was not significantly associated with the outcomes. Gender is the only risk factor significantly linked to severe lymphopenia.
Highlights
Lymphocytes play a key role in tumour response; they are the most sensitive cells to chemoradiation [1]
At the time of censoring, 38 (n = 73) and 196 (n = 459) patients experienced disease progression with severe and non-severe lymphopenia, respectively, and their median progression-free survival (PFS) was 20.53 and 60.33 months, respectively (Figure 2)
The median duration of locoregional control (LRC) was 56.3 months in severe lymphopenia, whereas it was not reached in non-severe lymphopenia (Figure 3)
Summary
Lymphocytes play a key role in tumour response; they are the most sensitive cells to chemoradiation [1]. According to Campian et al [2], lymphopenia is commonly seen during the administration of chemoradiation to head-and-neck cancer (HNC) patients. In a prospective study, combined treatment with cisplatin and radiotherapy induced lymphopenia in 78% of patients [3]. The current literature lacks information regarding its impact on various outcomes in locally advanced head-and-neck cancer patients in a prospective setting
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