Radiochemotherapy-related Lymphopenia in Head-and-Neck Cancer
Mihriban ERDOĞAN1,Murtaza PARVIZI2,Zeliha GÜZELÖZ1
1Department of Radiation Oncology, University of Health Sciences, Tepecik Training and Research Hospital, İzmir-Türkiye
2Department of Radiation Oncology, Manisa City Hospital, Manisa-Türkiye
DOI : 10.5505/tjo.2023.4017 OBJECTIVE
This study aimed to determine whether lymphopenia and neutrophil-to-lymphocyte ratio (NLR) could be prognostic factors of overall survival (OS), disease-free survival (DFS), or distant metastasis-free survival (DMFS) in patients with head-and-neck cancer (HNC) undergoing radical radiotherapy or chemoradiotherapy.

Eighty-four patients" medical records with HNC who underwent radical radiotherapy/ concurrent chemoradiotherapy were retrospectively included in the study. Blood tests were analyzed at the treatment's beginning, middle, and end. The degree of lymphopenia was categorized according to the Common Terminology Criteria for Adverse Events. The OS, DFS, and DMFS were calculated with the Kaplan-Meier method. In addition, univariate and multivariate Cox regression analyses were used to investigate the relationship between lymphopenia and survival.

The median follow-up time of patients was 20 months (range, 3-103). Forty-five deaths and a median 1-year OS of 76% were found. There was no difference in OS (median 27 months vs. 32 months, p=0.674) and DFS (30 months vs. 31 months, p=0.350) between patients who developed and did not develop lymphopenia during radiotherapy. However, survival was significantly worse in patients with G3 lymphopenia than in G1-2 patients (median 21 months vs. 49 months, p=0.033). When patients with an NLR of ≥4.9 and <4.9 were compared, no difference in OS (p=0.156) and DFS (p=0.830) was observed between these two groups. However, DMFS (43.1 months vs. 66.6 months, respectively, p=0.052) was worse in patients with high NLR (≥4.9).

Treatment-related G3 lymphopenia and high NLR rate are poor prognostic factors in patients with HNC. Keywords : Chemoradiotherapy; head and neck cancer; lymphopenia; neutrophil to lymphocyte ratio; overall survival