The Impact of Lymphopenia and Dosimetric Parameters on Overall Survival of Esophageal Cancer Patients Treated with Definitive Radiotherapy

PURPOSE: The objectives of the present study are to perform a survival analysis of patients with thoracic esophageal squamous cell carcinoma (ESCC) receiving definitive radiotherapy and to identify prognostic factors from among the hematological and dosimetric factors. METHODS: Cases of thoracic ESCC treated with radical RT between 2014 and 2017 were identified. The impact of clinicopathological factors on overall survival (OS) were analyzed using the Cox proportional hazards model. Absolute lymphocyte counts (ALC) and the neutrophil-to-lymphocyte ratio (NLR = ANC/ALC) were assessed before, during, and after radiotherapy (RT). Cox regression was used to correlate clinical factors with hematologic toxicities, dosimetric parameters and overall survival. Multiple logistic regression analysis was used to identify associations between lymphopenia and dosimetric parameters. With the overall survival status and real time events, the X-tile program was utilized to determine the optimal cut-off value of pretreatment NLR, and ALC nadir. RESULTS: Ninety-nine ESCC patients were enrolled in the present study. They had a median OS of 23 months. The median RT dose was 55.75Gy (46–66Gy), and the mean dose (D(mean)) of the thoracic vertebrae (TVB) was 27.04±9.65Gy. Based on the multivariate analysis, the V20 of TVB, the pretreatment NLR, and the ALC nadir were associated with significantly worse OS. Concurrent CRT, which entailed increasing the mean TVB dose and V20 of TVB, was linked to a higher probability of lymphopenia risk (P<0.05). This was ascertained through the multiple logistic regression analysis. CONCLUSION: In ESCC patients who received definitive RT, V(20) of TVB, pretreatment NLR, and ALC nadir during RT were independent prognostic factors and chemotherapy regimen, mean TVB dose, and V(20) of TVB were associated with lymphopenia.