Investigator
Shandong First Medical University
The Role of Lymphocyte Recovery Index in Prognosis Prediction for Locally Advanced Cervical Cancer With Radiation‐Induced Lymphopenia
ABSTRACTBackgroundIn patients with locally advanced cervical cancer (LACC) undergoing concurrent chemoradiotherapy (CCRT), the high incidence of radiation‐induced lymphopenia significantly affects prognosis. There are significant variations in lymphocyte count (ALC) recovery patterns among patients, and their impact on prognosis remains unclear. This study aims to quantify the lymphocyte recovery patterns by the lymphocyte recovery index (LRI) and evaluate its prognostic value.MethodsThis study reviewed patients with LACC who had ALCs available within 6 months post‐CCRT. Lymphopenia was graded using CTCAE 5.0, and lymphocyte recovery patterns were quantified using LRI (the ratio of ALCs at 6 months post‐treatment to baseline ALCs). Cox regression analysis was conducted to assess the correlation between LRI, other clinical factors, and survival. The dose–volume of bone marrow (BM) following pelvic radiotherapy was collected, and measurements of spleen standardized uptake value (SUV) and spleen‐to‐liver SUVmax ratio (SLR) were obtained from pre‐treatment 18F‐FDG PET/CT. Logistic regression analysis was used to identify independent risk factors for LRI.ResultsA total of 180 patients were included retrospectively. During CCRT, 53 patients (29.4%) experienced G4 lymphopenia. The median LRI was 53.4% (range 13.2%–159.4%). Multivariable analysis revealed that LRI, G4 lymphopenia, and FIGO stage were associated with progression‐free survival (PFS) and overall survival (OS). Subgroup analysis revealed that the degree of lymphopenia (G4 and G1‐3) did not affect the correlation between LRI and PFS (P: 0.001 and 0.011) or OS (P: 0.003 and 0.043). Regarding FIGO stage, the impact of LRI on PFS (p < 0.001) and OS (p < 0.001) was primarily observed in patients with FIGO stage > II. Logistic analysis identified BM‐V10 > 96.0% and SLR > 0.90 as independent risk factors for LRI.ConclusionIn patients with LACC after CCRT, the LRI is associated with prognosis. Splenic metabolism and BM irradiation are associated with lymphocyte recovery.
The Combined Prognostic Value of 18F‐FDG PET/CT Metabolic Parameters of Immune Organs and Hematological Immune‐Related Markers in Patients With Locally Advanced Cervical Cancer
ABSTRACTBackgroundThis study aimed to explore the prognostic value of fluorine‐18 fluorodeoxyglucose positron emission tomography/computed tomography (18F‐FDG PET/CT) metabolic parameters of immune organs and hematological immune‐related markers for patients with locally advanced cervical cancer (LACC) undergoing concurrent chemoradiotherapy (CCRT), and to establish prognostic nomograms based on these potential biomarkers.MethodsA total of 180 patients with LACC undergoing CCRT were retrospectively reviewed and randomly divided into training and validation groups at a 7:3 ratio. Cox regression analysis was performed to identify independent prognostic factors for progression‐free survival (PFS) and overall survival (OS) from hematological immune‐related markers and 18F‐FDG PET/CT metabolic parameters of the primary tumor, spleen, and bone marrow (BM). Nomograms were developed and evaluated using receiver operating characteristic curves, concordance index (C‐index), calibration curves, and decision curve analysis (DCA). Spearman correlation analysis was used to assess the relationships among metabolic parameters.ResultsMultivariable analysis identified International Federation of Gynecology and Obstetrics (FIGO) stage, neutrophil‐to‐lymphocyte ratio (NLR), and spleen maximum standardized uptake value (SUVspleen) as independent prognostic factors for PFS. For OS, the independent prognostic factors were FIGO stage, NLR, metabolic tumor volume, and SUVspleen. The nomograms demonstrated better prognostic performance for PFS (area under curve [AUC]: 0.875 and 0.862; C‐index: 0.809 and 0.775) and OS (AUC: 0.858 and 0.814; C‐index: 0.828 and 0.792) in the training and validation groups. Calibration curves and DCA indicated that the nomograms have good predictive accuracy and clinical utility. Spearman correlation analysis revealed significant positive correlations among total lesion glycolysis, SUVspleen, SUVBM, and platelet‐to‐lymphocyte ratio.ConclusionThe nomograms based on metabolic parameters of immune organs and hematological immune‐related markers demonstrated high predictive value for patients with LACC undergoing CCRT. The observed correlations between the metabolic parameters of the primary tumor and immune organs suggest a widespread disturbance of systemic immunity caused by the tumor.
