Abstract
PurposeTo explore the prognostic impact of combined tumor-infiltrating lymphocytes (TILs) and pretreatment peripheral lymphocyte percentage (LYM%) among patients with locally advanced nasopharyngeal carcinoma (LA-NPC).Patients and MethodsTILs and pretreatment LYM% were retrospectively assessed in 253 LA-NPC patients who underwent chemoradiation therapy between January 2012 and December 2017. According to TILs and LYM% status, the patients were divided into three groups: high-risk group (HRG) (TILs–LYM% score = 0), middle-risk group (MRG) (TILs–LYM% score = 1), and low-risk group (LRG) (TILs–LYM% score = 2). The relationship between TILs level and LYM%, and also the associations of TILs–LYM% status with clinicopathological factors and survival, were evaluated.ResultsAs a continuous variable, LYM% was significantly higher in TILs-high group. High TILs or high LYM% alone was significantly related to better 3-year disease-free survival (DFS), overall survival (OS), distant metastasis-free survival (DMFS) and locoregional relapse-free survival (LRRFS), respectively. Kaplan–Meier analysis and log-rank tests also revealed significant decreases in DFS, OS, DMFS, and LRRFS among LA-NPC patients with TILs–LYM% score of 0, 1, and 2 (all P <0.05). Further multivariate analyses showed that TILs–LYM% score was an independent factor affecting survival of the patients, and HRG (TILs–LYM% score = 0) had increased hazard ratios (HRs) for disease (HR = 6.89, P <0.001), death (HR = 8.08, P = 0.008), distant metastasis (HR = 7.66, P = 0.001), and local relapse (HR = 5.18, P = 0.013) compared with LRG (TILs–LYM% score = 2). In receiver operating characteristics (ROC) analyses, TILs–LYM% score had a higher area under the ROC curve (AUC) for the prediction of DFS than did TILs or LYM% alone.ConclusionsA positive correlation was found between TILs level and pretreatment blood lymphocyte percentage. Moreover, TILs–LYM% score can be considered as a novel independent prognostic indicator of survival outcome among patients with LA-NPC.
Highlights
Nasopharyngeal carcinoma (NPC) is a unique head and neck cancer when taking into consideration its special geographic distribution, with high incidence in Southern China, Epstein– Barr virus (EBV) associated etiology, and histology [1]
121 (47.8%) patients were defined as having lowTILs, and 132 (52.2%) patients as having high-tumor-infiltrating lymphocytes (TILs)
Based on the receiver operating characteristic (ROC) curve analysis results, the optimal blood lymphocyte percentage cut-off point that significantly associated with disease-free survival (DFS) was 27.0% (AUC = 0.625; Figure 2)
Summary
Nasopharyngeal carcinoma (NPC) is a unique head and neck cancer when taking into consideration its special geographic distribution, with high incidence in Southern China, Epstein– Barr virus (EBV) associated etiology, and histology [1]. Most nasopharyngeal cancer can be cured if detected at an early stage. Because the primary anatomical site of tumor growth is located in a cryptic site and is asymptomatic at early stages, NPC patients were usually diagnosed at an advanced stage, resulting in delayed treatment and causing poor long-term prognosis [2]. The Tumor-Node-Metastasis (TNM) system has been the most relevant clinicopathological variable for the prognostication of the locally advanced NPC (LA-NPC) patients undergoing oncologic treatment [3, 4]. The comprehensive TNM framework is merely based on the locoregional tumor expansions of the primary tumor, neglecting the substantial tumor- and host-related biological differences. New prognostic determinants which can reflect the biological and immunological heterogeneity of NPC are required to predict the clinical course of patients more reliably and precisely
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