严重的淋巴缺血预测直肠癌患者接受新辅助化学辐射治疗的生存率较差
Daniel W Kim1, Grace Lee1, Elise M Cai2
1From the Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
Cancer journal (Sudbury, Mass.)
|January 22, 2025
概括
化学辐射治疗后的严重淋巴缺血在直肠癌患者中很常见,预测生存率会更差. 监测高风险个体和探索治疗调整可能会改善结果.
科学领域:
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
背景情况:
- 化学辐射诱导的淋巴缺血是固体瘤中已知的不良事件,与预后较差有关.
- 在接受新辅助化学辐射治疗的直肠癌患者中,淋巴缺血的预后意义尚不清楚.
研究的目的:
- 为了研究在直肠癌中新辅助化学辐射后淋巴缺血的预后影响.
- 在这个患者群体中确定化疗辐射相关淋巴缺血的预测因素.
主要方法:
- 对接受新辅助化疗和手术的193名直肠腺癌患者的回顾性分析.
- 在治疗前和治疗后 (12周内) 评估了绝对淋巴细胞计数 (ALC).
- 淋巴缺血症根据CTCAE v5.0分级;严重的淋巴缺血症被定义为ALC<500/μL. 总生存率 (OS) 和无疾病生存率 (DFS) 用考克斯建模和卡普兰-梅尔方法进行了分析.
主要成果:
- 57%的患者经历了严重的淋巴缺血.
- 较低的基线ALC是严重淋巴缺血症 (OR, 1.71) 的显著预测因素.
- 严重的淋巴缺血与明显恶化的DFS (HR, 2.64) 和OS (HR, 4.32) 相关. 五年的OS分别为79%与92%和5年的DFS分别为70%与86%的严重淋巴缺血和没有严重的淋巴缺血群.
结论:
- 化学辐射诱导的淋巴缺血是直肠癌中普遍存在和显著的负面预后标志物.
- 确定高风险患者进行更密切的监测和潜在的治疗修改是有必要的.
- 这些发现突出了宿主免疫在直肠癌结果中的作用,并建议进一步研究减轻治疗诱导的淋巴衰竭.
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