Abstract

Chemoradiation therapy of inoperable locally advanced esophageal cancer (LAEC), although improving outcomes of patients, still results in 50% of recurrence, which may be facilitated by the recruitment of circulating tumor cells to pro-inflammatory microenvironments in the absence of lymphocytes. Also, radiation can both suppress and stimulate the immune system. This study aimed to investigate the radiation induced-systemic inflammation changes in LAEC for early predicting treatment response to radiotherapy. Subjects consisted of 213 LAEC patients (median age of 66 years) who had received definitive thoracic radiotherapy with a median dose of 60Gy and 30fx, and 76% received concurrent chemotherapy. Peripheral blood was collected pre-RT, at week 2 during RT (mid-RT) and post-RT for each patient and analyzed by using automated flow cytometry. Neutrophil: lymphocyte ratio (NLR), platelet: lymphocyte ratio (PLR) were calculated for each complete blood count. Associations between plan tumor volumes (PTVs) with hematologic parameters pre-RT, mid-RT, post-RT and their changes during RT were assessed with Spearman correlation coefficients. Associations of the hematologic parameters with progression-free survival (PFS) of patients were analyzed by Cox proportional hazards regression analysis. With a median follow-up period of 36.3 months (range 24-44.8 months), median PFS was xx months. For all patients, the median PTV was 405.7±17.2 cc. Smaller PTVs were correlated with lower mid-RT NLR (r = 0.35; p = .000) and lower mid-RT PLR (r = 0.27; p = .000). On univariate analysis, Lower NLR (p = .04) and PLR (p = .01) at mid-RT and more decreasing in NLR (p = .001) and PLR (p = .004) at mid-RT were associated with longer PFS (Table 1). No significant predictive effects were shown in NLR or PLR at pre-RT or post-RT. Lower NLR and PLR during definitive radiotherapy were associated with smaller PTVs and longer PFS in LAEC. It indicated that peripheral inflammation following radiotherapy for LAEC may be a novel prognostic biomarker for radiotherapy response and further studies are needed to develop treatment strategies. Table 1. Univariable and multivariable Cox proportional hazards regression analysis.Abstract 3417; TableUnivariable analysisMultivariable analysisHR95%CIP valueHR95%CIP valueNLRpre-RT1.180.78-1.810.45NLRmid-RT1.591.03-2.440.04*0.640.30-1.370.25NLRpost-RT0.920.60-1.400.68NLRearlychange2.051.33-3.150.001*2.371.12-5.000.02*NLRchange0.860.56-1.330.50PLRpre-RT.760.61-1.430.76PLRmid-RT1.721.12-2.640.01*1.200.68-2.150.53PLRpost-RT1.240.81-1.900.32PLRearlychange1.901.23-2.920.004*1.440.82-2.540.21PLRchange1.310.85-2.000.22* statistically significant. Open table in a new tab

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