[an error occurred while processing this directive]|[an error occurred while processing this directive]
外周血淋巴细胞与单核细胞比值变化对食管癌调强放疗预后影响
李黎1,2, 李曙光1, 闫可1, 宋春洋1, 赵彦1, 王旋1, 史鸿云2, 祝淑钗1
1河北医科大学第四医院放疗科,石家庄 050011; 2河北大学附属医院放疗科,保定 071000
Effect of peripheral blood lymphocyte-to-monocyte ratio on prognosis of esophageal cancer patients treated with intensity-modulated radiotherapy
Li Li1, 2, Li Shuguang1, Yan Ke1, Song Chunyang1, Zhao Yan1, Wang Xuan1, Shi Hongyun2, Zhu Shuchai1
1Department of Radiation Oncology,Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China; 2Department of Radiation Oncology,Affiliated Hospital of Hebei University,Baoding 071000,China
Abstract：Objective To observe the variation trend of the peripheral blood lymphocyte-to-monocyte ratio (LMR) during radiotherapy in patients with esophageal cancer and analyze the relationship between LMR and the radiation-induced injury, aiming to provide parameters for accurate evaluation of radiotherapy responses and clinical efficacy. Methods Clinical data of 248 eligible patients undergoing definitive radiotherapy in our department from January 2013 to December 2015,248 were retrospectively analyzed. The routine peripheral blood examination was performed weekly before, during and at the end of radiotherapy. The absolute number of lymphocyte and monocyte was recorded to calculate the LMR. The standard classification of LMR value was conducted based on the median value of each parameter. All data including the lesion length, lesion location, clinical stage and LMR were analyzed using the Kaplan-Meier, cox and logistic regression methods, respectively. Results LMR displayed an exponential decline during radiotherapy. Univariate analysis showed that the average LMR value was the influential factor of overall survival (P=0.011) and progression-free survival (P=0.017). The mean LMR value almost exerted significant effect upon local control rate (P=0.053). No significant correlation was observed between the mean LMR value and radioactive esophagitis and pneumonitis. Stratified analysis based on the results of multivariate analysis demonstrated that patients with higher average LMR value still had longer survival. Logistic regression model revealed that the length of esophageal lesion and irradiation pattern were the influential factors of the mean LMR value. Conclusions LMR value displays an exponential decline during radiotherapy. The greater amplitude prompts the worse prognosis. The wider the irradiation field and the greater decrease in LMR exert more obvious impact on the prognosis.
Li Li,Li Shuguang,Yan Ke et al. Effect of peripheral blood lymphocyte-to-monocyte ratio on prognosis of esophageal cancer patients treated with intensity-modulated radiotherapy[J]. Chinese Journal of Radiation Oncology, 2019, 28(10): 741-745.
[1] Man Y,Stojadinovic A,Mason J,et al,Tumor-infiltrating immune cells promoting tumor invasion and metastasis:existing theories[J]. J Cancer,2013,4(1):84-95. DOI:10.7150/jca.5482. [2] Formenti SC,Demaria S,Effects of chemoradiation on tumor-host interactions:the immunologic side[J]. J Clin Oncol,2008,26(9):1562. DOI:10.1200/JCO.2007.15.5499. [3] SStotz M,Pichler M,Absenger G,et al,The preoperative lymphocyte to monocyte ratio predicts clinical outcome in patients with stage Ⅲ colon cancer[J]. Br J Cancer,2014,110(2):435. DOI:10.1038/bjc.2013.785. [4] Szkandera J,Gerger A,Lieglatzwanger B,et al,The lymphocyte/monocyte ratio predicts poor clinical outcome and improves the predictive accuracy in patients with soft tissue sarcomas[J]. Int J Cancer,2014,135(2):362-370. DOI:10.1002/ijc.28677. [5] Li J,Jiang R,Liu WS,et al,A large cohort study reveals the association of elevated peripheral blood lymphocyte-to-monocyte ratio with favorable prognosis in nasopharyngeal carcinoma[J/OL]. Plos One,2013,8(12):e83069. DOI:10.1371/journal.pone.0083069. [6] Go SI,Kim RB,Song HN,et al,Prognostic significance of the lymphocyte-to-monocyte ratio in patients with small cell lung cancer[J]. Med Oncol,2014,31(12):323. DOI:10.1007/s12032-014-0323-y. [7] Han LH,Jia YB,Song QX,et al,Prognostic significance of preoperative lymphocyte-monocyte ratio in patients with resectable esophageal squamous cell carcinoma[J]. As Paci J Cancer Prevent,2015,16(6):2245-2250. DOI:10.7314/apjcp.2015.16.6.2245. [8] Nishijima TF,Muss HB,Shachar SS,et al,Prognostic value of lymphocyte-to-monocyte ratio in patients with solid tumors:A systematic review and meta-analysis[J]. Cancer Treat Rev,2015,41(10):971-978. DOI:10.1016/j.ctrv.2015.10.003. [9] 中国非手术治疗食管癌临床分期专家小组,非手术治疗食管癌的临床分期标准(草案)[J]. 中华放射肿瘤学杂志,2010,19(3):179-180. DOI:10.3760/cma.j.issn.1004-4221.2010.03.001. Chinese non surgical treatment of clinical staging of esophageal cancer expert group,Clinical non operative treatment of esophageal cancer staging criteria (Draft)[J]. Chin J Radiat Oncol,2010,19(3):179-180. DOI:10.3760/cma.j.issn.1004-4221.2010.03.001. [10] 李红云,祝淑钗,苏景伟,等,食管癌根治性放化疗长期生存影响因素分析[J]. 中华放射肿瘤学杂志,2016,25(11):1177-1181. DOI:10.3760/cma.j.issn.1004-4221.2016.11.007. Li HY,Zhu SC,Su JW,et al,An analysis of the influencing factors for long-term survival in patients with esophageal carcinoma undergoing radical chemoradiotherapy[J]. Chin J Radiat Oncol,2016,25(11):1177-1181. DOI:10.3760/cma.j.issn.1004-4221.2016.11.007. [11] Cox JD,StetzJ,Paiak TF,Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC)[J]. Int J Radial Oncol Biol Phys,1995,31:1341-1346. [12] Porrata LF,Ristow K,Habermann TM,et al,Peripheral blood lymphocyte/monocyte ratio at diagnosis and survival in nodular lymphocyte-predominant Hodgkin lymphoma[J]. Br J Haematol,2012,157(3):321-330. DOI:10.1111/j.1365-2141.2012.09067.x. [13] Li YL,Pan YY,Jiao Y,et al,Peripheral blood lymphocyte/monocyte ratio predicts outcome for patients with diffuse large B cell lymphoma after standard first-line regimens[J]. An Hematol,2014,93(4):617-626. DOI:10.1007/s00277-013-1916-9. [14] Ubukata H,Motohashi G,Tabuchi T,et al,Evaluations of interferon-γ/interleukin-4 ratio and neutrophil/lymphocyte ratio as prognostic indicators in gastric cancer patients.[J]. J Surg Oncol,2010,102(7):742-747. DOI:10.1002/jso.21725. [15] O′Callaghan DS,O′Donnell D,O′Connell F,et al,The role of inflammation in the pathogenesis of non-small cell lung cancer[J]. J Thorac Oncol,2010,5(12):2024. DOI:10.1097/JTO.0b013e3181f387e4. [16] Nazir T,Islam A,Omer M O,et al,Lymphocytopenia;induced by vinorelbine,doxorubicin and cisplatin in human cancer patients[J]. Breast Dis,2015,35(1):1-4. DOI:10.3233/BD-140386. [17] Krstic J,Santibanez JF,Transforming growth factor-Beta and matrix metalloproteinases:functional interactions in tumor stroma-infiltrating myeloid cells[J]. Sci World J,2014(1):521754. DOI:10.1155/2014/521754. [18] Schaue D,Comin-Anduix B,Ribas A,et al,T-cell responses to survivin in cancer patients undergoing radiation therapy[J]. Clin Cancer Res,2008,14(15):4883-4890. DOI:10.1158/1078-0432. CCR-07-4462. [19] Lin XM,Li MH,Zhao F,et al. The lymphocyte-monocyte ratio predicts tumor response and survival in patients with locally advanced esophageal cancer who received definitive chemoradiotherapy[J]. Oncotarg Ther,2017,Volume 10:871-877. DOI:10.2147/OTT. S124915. [20] Maclennan IC,Kay HE,Analysis of treatment in childhood leukemia,Ⅳ,The critical association between dose fractionation and immunosuppression induced by cranial irradiation[J]. Cancer,1978,41(1):108-111. [21] Weeke E,The development of lymphopenia in uremic patients undergoing extracorporeal irradiation of the blood with portable beta units[J]. Radiat Res,1973,56(3):554-559.
2019, Vol. 28 
