Zhongguo aizheng zazhi (Oct 2023)
Impact of body dose parameters on circulating immune cells in locally advanced nasopharyngeal carcinoma patients: a retrospective cohort study
Abstract
Background and purpose: The implementation of intensity-modulated radiotherapy (IMRT) has significantly enhanced the survival outcomes for patients with nasopharyngeal carcinoma (NPC). However, this therapeutic approach still falls short in meeting the prognostic requirements of individuals with locally advanced NPC (LANPC). Therefore, it is imperative to identify effective prognostic markers to enhance the efficacy of radiotherapy and achieve personalized treatment. Given the potential predictive value demonstrated in previous studies regarding radiotherapy-related body dose parameters and immune blood cells, this study aimed to investigate the correlation between body dose parameters and reduced immune cells and patient prognosis during radiotherapy in LANPC patients. Methods: Clinical data of 423 patients with LANPC (stage Ⅲ-Ⅳa) treated in Fudan University Shanghai Cancer Center from Jan.1, 2012 to Dec. 31, 2016 were retrospectively analyzed. Percentage changes of different immune blood cells during radiotherapy were also collected. Cox proportional hazard model was used to determine prognostic factors for overall survival (OS), locoregional recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS). Body dose-based parameters were extracted from dose-volume histograms (DVHs). Logistic regression was applied to determine parameters that could predict white blood cells reduction. Results: High ΔLYM% (ΔLYM%≥7 7.0%) and high ΔMONO% (ΔMONO%≥2 8.5%) were identified as two adverse prognostic factors in LANPC patients. In multivariable analysis, high ΔLYM% was found to be a significant predictor of worse OS (HR = 1.672, P = 0.012), LRFS (HR = 1.712, P = 0.006), and DMFS (HR = 1.971, P = 0.001). High ΔMONO% was associated with worse OS (HR = 1.355, P = 0.015) and DMFS (HR = 1.704, P = 0.003). The change of ΔLYM% was influenced by the integral body dose (IBD) (OR = 1.004, P = 0.037) and body V60 (OR = 1.046, P = 0.036). ΔMONO% was significantly affected by body V55 (OR = 1.144, P = 0.009) and V70 (OR = 0.734, P = 0.022). Conclusion: Integral body dose, V60, and V55, V70 can serve as dose-volume constraints to retain sufficient immune cell populations to improve prognosis.
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