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. 2023 May 21;9(6):e16483.
doi: 10.1016/j.heliyon.2023.e16483. eCollection 2023 Jun.

Prophylactic cranial irradiation-related lymphopenia affects survival in patients with limited-stage small cell lung cancer

Xinyu Fan  1 , Linlin Yang  1 , Wenru Qin  1 , Bing Zou  1 , Bingjie Fan  1 , Shijiang Wang  1   2 , Linlin Wang  1   2
Affiliations

Prophylactic cranial irradiation-related lymphopenia affects survival in patients with limited-stage small cell lung cancer

Xinyu Fan et al. Heliyon. .

Abstract

Background: The study aimed to identify the relations of the absolute lymphocyte count (ALC) nadir during prophylactic cranial irradiation (PCI) and patient outcomes in limited-stage small cell lung cancer (LS-SCLC).

Methods: We analyzed 268 L S-SCLC patients who underwent PCI from 2012 to 2019. ALC values were collected prior, during, and 3 months post PCI. Kaplan-Meier and Cox regression analyses were performed to assess the relation of ALC to patient prognosis. Two nomograms were developed on the basis of clinical variables for survival prediction.

Results: Compared with the ALC before PCI (1.13 × 109 cells/L), the ALC nadir during PCI was significantly reduced by 0.68 × 109 cells/L (P < 0.001) and raised to 1.02 × 109 cells/L 3 months post PCI. Patients with a low ALC nadir during PCI (<0.68 × 109 cells/L) had inferior progression free survival (PFS) (median PFS: 17.2 m vs. 43.7 m, P = 0.019) and overall survival (OS) (median OS: 29.0 m vs 39.1 m, P = 0.012). Multivariate Cox analysis revealed that age, smoking history, clinical stage, and ALC nadir were independent OS (P = 0.006, P = 0.005, P < 0.001 and P = 0.027, respectively), as well as independent PFS predictors (P = 0.032, P = 0.012, P = 0.012 and P = 0.018, respectively). After internal cross-validation, the corrected concordance indices of the predictive nomograms for PFS and OS were 0.637 and 0.663, respectively.

Conclusion: LS-SCLC patients with a low ALC nadir during PCI likely have worse survival outcomes. Dynamic evaluation of the ALC during PCI is recommended for LS-SCLC patients.

Keywords: Limited-stage small-cell lung cancer (LS-SCLC); Lymphopenia; Overall survival (OS); Prophylactic cranial irradiation (PCI).

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper

Figures

Fig. 1
Fig. 1
The absolute lymphocyte count (ALC) trend before prophylactic cranial irradiation (pre-PCI) to 3 months after PCI (post-PCI).
Fig. 2
Fig. 2
Kaplan–Meier curves showing clinical outcomes of patients:(a) PFS, (b) OS, and between patients with a high ALC nadir (green line) and with a low ALC nadir (red line) during PCI. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Fig. 3
Fig. 3
The development of a nomogram model to predict the progression free survival (PFS) of limited-stage small cell lung cancer (LS-SCLC) patients with prophylactic cranial irradiation (PCI). (a) Nomogram for 6- and 12-month PFS prediction. (b) Calibration plots for predicting 12-month PFS outcomes. On the calibration plot, nomogram-predicted probability of 12-month PFS is plotted on the x-axis while the actual 12-month PFS is plotted on the y-axis. The reference line is 45° and indicates perfect calibration. (c) The area under the curve (AUC) of the prognostic nomogram models for 12-month PFS is 0.7019.
Fig. 4
Fig. 4
The development of a nomogram model to predict the overall survival (OS) of LS-SCLC patients with PCI. (a) Nomogram for 1- and 3-year OS prediction. (b) Calibration plots for predicting 3-year OS outcomes. On the calibration plot, nomogram-predicted probability of 3-year OS is plotted on the x-axis while the actual 3-year OS is plotted on the y-axis. The reference line is 45° and indicates perfect calibration. (c) The area under the curve (AUC) of the prognostic nomogram models for 3-year OS is 0.6865.
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References

    1. Rudin C.M., Brambilla E., Faivre-Finn C., et al. Small-cell lung cancer. Nat. Rev. Dis. Prim. 2021;7:3. - PMC - PubMed
    1. van Meerbeeck J.P., Fennell D.A., De Ruysscher D.K. Small-cell lung cancer. Lancet. 2011;378:1741–1755. - PubMed
    1. Govindan R., Page N., Morgensztern D., et al. Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J. Clin. Oncol. 2006;24:4539–4544. - PubMed
    1. Wang S., Zimmermann S., Parikh K., et al. Current diagnosis and management of small-cell lung cancer. Mayo Clin. Proc. 2019;94:1599–1622. - PubMed
    1. Faivre-Finn C., Snee M., Ashcroft L., et al. Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT): an open-label, phase 3, randomised, superiority trial. Lancet Oncol. 2017;18:1116–1125. - PMC - PubMed

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