ABSTRACT
Objective:To evaluate the effects of the nadirs of neutrophils and lymphocytes during concurrent chemoradiotherapy (CCRT) on clinical prognosis of patients with cervical cancer, aiming to provide reference data for clinicians.Methods:Clinical data of FIGO (2018)Ⅰ B1-Ⅳ A cervical cancer patients treated with radical CCRT in the University of Hong Kong-Shenzhen Hospital, from January 2015 to September 2019 were analyzed. Routine blood test was performed weekly. The overall survival (OS) was calculated by Kaplan- Meier method and analyzed by log-rank test. Univariate and Multivariate prognostic analysis were performed by Cox proportional hazards model. Results:A total of 87 patients were included. The cutoff values of absolute neutrophil count nadir (ANC n) and absolute lymphocyte count nadir (ALC n) for predicting OS were determined by receiver operating characteristic curve. Compared with the ANC n of ≤2.14×10 9/L ( n=76), patients with the ANC n of > 2.14×10 9/L ( n=11) had lower 2-year OS rate (54.5% vs. 88.9%, P=0.035). Compared with ALC n of > 0.2×10 9/L ( n=49), patients with ALC n of ≤0.2×10 9/L ( n=38) obtained lower 2-year OS rate (75.3% vs. 90.8%, P=0.008). Multivariate analysis showed that ANC n (>2.14×10 9/L vs. ≤2.14×10 9/L)( HR=4.487, 95% CI: 1.404-14.344, P=0.011), ALC n (≤0.2×10 9/L vs. >0.2×10 9/L)( HR=5.814, 95% CI: 1.822-18.554, P=0.003), concurrent chemotherapy cycle (5-6 cycles vs. 0-4 cycles)( HR=0.204, 95% CI: 0.060-0.696, P=0.011) and the mean body radiation dose ( HR=1.296, 95% CI: 1.125-1.493, P<0.001) were significantly associated with OS. Patients with the ANC of > 5.19×10 9/L before CCRT were more likely to have ANC n of > 2.14×10 9/L during CCRT and those with the ALC of < 2.05×10 9/L before CCRT was more likely to have ALC n of ≤0.2×10 9/L during CCRT. Conclusions:Peripheral ANC n and ALC n during CCRT have different prognostic effects and influencing factors. Clinical prognosis of cervical cancer patients may be improved by closely monitoring routine blood parameters and optimizing treatment modality during CCRT.