Impact of radiotherapy on circulating lymphocyte subsets in patients with esophageal cancer.

Radiotherapy (RT) can affect the immune function of patients with cancer. The purpose of this study was to investigate the effect of RT on lymphocyte and its subsets in patients with esophageal cancer (EC).All patients received RT with a mean dose of 5369 cGy (gray). Blood parameters were measured in 31 patients on 3 occasions (before, at the end of radiotherapy, and at 3 months follow-up). The whole blood count and lymphocyte subsets were measured and correlated with short time efficiency and radiation dose parameters.White blood count (WBC) and lymphocyte count (ALC) were greatly decreased at the end of radiotherapy, and the percentages of CD3+, CD3+CD8+ T cells were significantly increased, on the other hand, a decrease in the CD4/CD8 ratio was observed. The percentages of CD3-CD16/56+NK cells and CD19+ B cell were decreased at the end of RT compared with prior RT. The percentages of CD3+ T cells before RT and the WBC and ALC count after RT can be used as prognostic indicators for survival. The PTV dose can cause significant changes in lymphocytes count after RT. CD3+T cells after RT were significantly correlated with mean heart dose and heart V50.Our study identified that RT causes changes in lymphocyte subsets, and these changes may indicate differences in immune function between individuals. Radiotherapy plan should be designed to minimize normal tissue dose to reduce the impact on WBC and lymphocytes.

Prognostic value of combined preoperative prognostic nutritional index and neutrophil to lymphocyte ratio in esophageal squamous cell carcinoma.

BACKGROUND: Preoperative nutritional status and some inflammatory indexes are associated with survival in various malignancies. Prognostic nutritional index (PNI) or neutrophil to lymphocyte ratio (NLR) was demonstrated associated with survival in patients with esophageal squamous cell carcinoma (ESCC). The purpose of the present study was to investigate whether the combination index of PNI and NLR (PNI-NLR) is superior to either alone in survival prognosis of patients with ESCC. METHODS: In total, 271 patients with ESCC who underwent radical esophagectomy from Qianfoshan Hospital from May 2009 to July 2014 were enrolled. Preoperative PNI and other clinical data were collected and analyzed. Using the 5-year survival rate as an end point, a receiver operating characteristic (ROC) analysis was used to find the best cutoff value for PNI and NLR was 49.1 and 3.14, respectively. And all the enrolled patients were classified into three groups: group 1 (score 0, NLR ≤3.14 and PNI >49.1), group 2 (score 1, NLR >3.14 or PNI ≤49.1) and group 3 (score 2, NLR >3.14 and PNI ≤49.1). RESULTS: The combined index of PNI-NLR was a sensitive index in survival prognosis, and patients in the group 1, 2 and 3 had median survival times of 64, 47 and 36 months, respectively. Patients in group1 had significantly longer survival time than those of group 2 and group 3. In multivariate analyses, TNM stage, lymph stage, PNI and PNI-NLR affected the overall survival (OS). PNI was significantly correlated with TNM stage. CONCLUSIONS: Preoperative PNI-NLR was an independent predictor of survival of patients with ESCC. The index of PNI-NLR can improve the accuracy of prognoses for patients with ESCC than the index of NLR.