Distribution of Peripheral Blood Cells in Esophageal Cancer Patients During Concurrent Chemoradiotherapy Predicts Long-Term Locoregional Progression Hazard After Treatment (GASTO1072)

Abstract

Liangyu Xu,1,2,* Jianzhou Chen,1,* Hong Guo,1 Ruihong Huang,1 Longjia Guo,1 Yuanxiang Yu II,1 Tiantian Zhai,1 Fangcai Wu,1 Zhijian Chen,1,3 Derui Li,1 Chuangzhen Chen1 1Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, 515031, People’s Republic of China; 2Department of Radiation Oncology, Dongguan Tungwah Hospital, Dongguan, 523110, People’s Republic of China; 3Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chuangzhen ChenDepartment of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, Guangdong, 515031, People’s Republic of ChinaTel/Fax [phone]Email [email protected]: Predicting the response to chemoradiotherapy is critical for the optimal management of esophageal cancer; however, it remains an unmet clinical need. This study aimed to evaluate the predictive potential of peri-treatment peripheral blood cells (PBC) in disease progression hazard in esophageal cancer following chemoradiotherapy.Patients and Methods: A total of 87 patients with primary esophageal squamous cell carcinoma were subjected to definitive concurrent chemoradiotherapy in a Phase II trial. PBC parameters (hemoglobin, neutrophils, platelets, lymphocytes, and monocytes) were collected at seven time points throughout the course of radiotherapy. The potential of peri-treatment PBC parameters to predict the 3-year cumulative hazard of tumor progression was evaluated.Results: Patients with disease progression displayed distinct distribution patterns of peri-treatment PBC compared to that in patients without disease progression. Greater prediction capabilities for risk of locoregional disease progression were found in PBC collected after the start of radiotherapy compared to those in their pretreatment counterparts, and in individual parameters rather than cell-to-cell ratios. The most predictive PBC parameters were integrated by summation and designated as a PBC score (PBCS), which further augmented their predictive power. Patients classified according to their PBCS (high vs medium v. low) had significantly different 3-year cumulative hazards of locoregional progression (58% vs 29% vs 7%, P = 0.0017). Multivariate analysis confirmed that high PBCS (HR, 12.2; 95% CI, 2.0– 76.3; P = 0.007) and medium (HR, 5.8; 95% CI 1.2– 27.7; P = 0.028) were independent indicators of locoregional progression.Conclusion: Systematic analysis of PBC distribution in esophageal cancer patients undergoing definitive chemoradiotherapy could help predict long-term locoregional progression hazard after treatment.Keywords: peripheral blood cell parameters, integration, discriminatory capacity, tumor control failure, esophageal squamous cell carcinoma, chemoradiotherapy

Keywords

• peripheral blood cell parameters
• integration
• discriminatory capacity
• tumor control failure
• esophageal squamous cell carcinoma
• chemoradiotherapy.