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Lymphopenia, IL6, and CCL2 after thoracic radiotherapy predict poor prognosis in patients with lung cancer
Jenny Ling-Yu Chen1, Yu-Sen Huang2, Yong-Han Su3
1Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Department of Radiation Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.
Background/Purpose:
This study evaluated the impact of lymphopenia and serum biomarkers, including interleukin-6 (IL-6) and chemokine (C-C motif) ligand 2 (CCL2), on survival in patients with NSCLC treated with curative-intent thoracic radiotherapy.
Methods:
Seventy-five patients with NSCLC treated with curative-intent thoracic radiotherapy were included. Baseline and post-radiotherapy lymphocyte counts, serum IL-6, and CCL2 levels were assessed. Survival outcomes, including overall survival (OS) and progression-free survival (PFS), were analyzed.
Results:
At baseline, patients with NSCLC exhibited significantly elevated serum IL-6 and CCL2 levels compared to those of healthy controls (p < 0.05). Thoracic radiotherapy significantly decreased lymphocyte counts (p < 0.001). Severe lymphopenia and elevated post-treatment IL-6 and CCL2 levels correlated with shorter OS and PFS (p < 0.05). Patients with the three prognostic factors-severe lymphopenia and elevated post-treatment IL-6 and CCL2 levels-exhibited the poorest outcomes, with an estimated mean PFS of 13.5 months and OS of 29.7 months. Notably, these biomarkers demonstrated greater prognostic value in the advanced-stage subgroup. Moreover, bioinformatics analysis revealed that elevated CCL2 expression was associated with poorer clinical outcomes, an immunogenic tumor microenvironment, and upregulation of immune-related pathways, making it a potential biomarker for prognosis and treatment.
Conclusion:
Post-treatment lymphopenia and elevated serum IL-6 and CCL2 are significant prognostic markers in patients with NSCLC undergoing thoracic radiotherapy. Immunologic evaluation may guide adjuvant treatment strategies in NSCLC treated with radiotherapy.
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