Severe Radiation-Induced Lymphopenia Affects the Outcomes of Esophageal Cancer: A Comprehensive Systematic Review and Meta-Analysis
The aim of the current study was to evaluate the influence of severe radiation-induced lymphopenia (RIL) on the outcomes of esophageal cancer (EC). A systematic review and meta-analysis was performed through the PRISMA guideline. Seventeen studies were included in the current systematic review, with...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-06-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/12/3024 |
| _version_ | 1797489145338134528 |
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| author | Dongjun Dai Qiaoying Tian Genhua Yu Yongjie Shui Hao Jiang Qichun Wei |
| author_facet | Dongjun Dai Qiaoying Tian Genhua Yu Yongjie Shui Hao Jiang Qichun Wei |
| author_sort | Dongjun Dai |
| collection | DOAJ |
| description | The aim of the current study was to evaluate the influence of severe radiation-induced lymphopenia (RIL) on the outcomes of esophageal cancer (EC). A systematic review and meta-analysis was performed through the PRISMA guideline. Seventeen studies were included in the current systematic review, with eight included in the meta-analyses. Meta-analyses found that severe RIL was associated with lower pathologic complete response (pCR) rate (odds ratio (OR) = 0.44, 95% confidence interval (CI) = 0.30–0.66, I<sup>2</sup> = 0%), inferior overall survival (OS) (hazard ratio (HR) = 1.50, 95% CI = 1.29–1.75, I<sup>2</sup> = 6%), and worse progression-free survival (PFS) (HR = 1.70, 95% CI = 1.39–2.07, I<sup>2</sup> = 0%) of EC patients. The lymphocyte nadir was found during 4–6 weeks after the start of radiotherapy. The leading dosimetric factors associated with severe RIL included larger PTV, higher dose to heart and body, and higher effective dose to the immune cells (EDIC). Clinical risk factors for RIL mainly comprised lower baseline ALC, higher tumor length and clinical stage, and distal EC. In conclusion, severe RIL might be associated with a lower pCR rate and worse OS and PFS of EC patients. Minimizing the dosimetric risk factors, especially in patients with clinical risk factors, might benefit their outcomes. |
| first_indexed | 2024-03-10T00:12:20Z |
| format | Article |
| id | doaj.art-b366bab4458443118377fd276f7ae720 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T00:12:20Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-b366bab4458443118377fd276f7ae7202023-11-23T15:58:09ZengMDPI AGCancers2072-66942022-06-011412302410.3390/cancers14123024Severe Radiation-Induced Lymphopenia Affects the Outcomes of Esophageal Cancer: A Comprehensive Systematic Review and Meta-AnalysisDongjun Dai0Qiaoying Tian1Genhua Yu2Yongjie Shui3Hao Jiang4Qichun Wei5Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, ChinaDepartment of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, ChinaDepartment of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, ChinaDepartment of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, ChinaAnhui Campus of the Second Affiliated Hospital, Zhejiang University School of Medicine, Bengbu 233000, ChinaDepartment of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, ChinaThe aim of the current study was to evaluate the influence of severe radiation-induced lymphopenia (RIL) on the outcomes of esophageal cancer (EC). A systematic review and meta-analysis was performed through the PRISMA guideline. Seventeen studies were included in the current systematic review, with eight included in the meta-analyses. Meta-analyses found that severe RIL was associated with lower pathologic complete response (pCR) rate (odds ratio (OR) = 0.44, 95% confidence interval (CI) = 0.30–0.66, I<sup>2</sup> = 0%), inferior overall survival (OS) (hazard ratio (HR) = 1.50, 95% CI = 1.29–1.75, I<sup>2</sup> = 6%), and worse progression-free survival (PFS) (HR = 1.70, 95% CI = 1.39–2.07, I<sup>2</sup> = 0%) of EC patients. The lymphocyte nadir was found during 4–6 weeks after the start of radiotherapy. The leading dosimetric factors associated with severe RIL included larger PTV, higher dose to heart and body, and higher effective dose to the immune cells (EDIC). Clinical risk factors for RIL mainly comprised lower baseline ALC, higher tumor length and clinical stage, and distal EC. In conclusion, severe RIL might be associated with a lower pCR rate and worse OS and PFS of EC patients. Minimizing the dosimetric risk factors, especially in patients with clinical risk factors, might benefit their outcomes.https://www.mdpi.com/2072-6694/14/12/3024esophageal cancerradiation therapylymphopeniapathologic complete responsesurvival outcomeseffective dose to the immune cells |
| spellingShingle | Dongjun Dai Qiaoying Tian Genhua Yu Yongjie Shui Hao Jiang Qichun Wei Severe Radiation-Induced Lymphopenia Affects the Outcomes of Esophageal Cancer: A Comprehensive Systematic Review and Meta-Analysis Cancers esophageal cancer radiation therapy lymphopenia pathologic complete response survival outcomes effective dose to the immune cells |
| title | Severe Radiation-Induced Lymphopenia Affects the Outcomes of Esophageal Cancer: A Comprehensive Systematic Review and Meta-Analysis |
| title_full | Severe Radiation-Induced Lymphopenia Affects the Outcomes of Esophageal Cancer: A Comprehensive Systematic Review and Meta-Analysis |
| title_fullStr | Severe Radiation-Induced Lymphopenia Affects the Outcomes of Esophageal Cancer: A Comprehensive Systematic Review and Meta-Analysis |
| title_full_unstemmed | Severe Radiation-Induced Lymphopenia Affects the Outcomes of Esophageal Cancer: A Comprehensive Systematic Review and Meta-Analysis |
| title_short | Severe Radiation-Induced Lymphopenia Affects the Outcomes of Esophageal Cancer: A Comprehensive Systematic Review and Meta-Analysis |
| title_sort | severe radiation induced lymphopenia affects the outcomes of esophageal cancer a comprehensive systematic review and meta analysis |
| topic | esophageal cancer radiation therapy lymphopenia pathologic complete response survival outcomes effective dose to the immune cells |
| url | https://www.mdpi.com/2072-6694/14/12/3024 |
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