Oropharyngeal cancer: lymphopenia tied to recurrence risk

  • Lin AJ & al.
  • JAMA Otolaryngol Head Neck Surg
  • 28 Mar 2019

  • curated by Brian Richardson, PhD
  • Univadis Clinical Summaries
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Takeaway

  • High-grade lymphopenia after radiotherapy (RT) initiation may identify patients at risk for recurrence of HPV-negative oropharyngeal cancer (OPC).

Why this matters

  • 3-month data may help select patients for adjuvant treatment intensification or closer surveillance.

Key results

  • 29.2% of patients had grade 3/4 lymphopenia 3 months after RT initiation.
    • T3/T4 tumor stage was associated with the development of grade 4 lymphopenia (OR, 5.3; 95% CI, 1.4-20.0 vs T1/T2 tumors).
  • Patients with grade 3/4 lymphopenia at 3 months after RT initiation had reduced 3-year recurrence-free survival (RFS) (43% vs 66%) and OS (54% vs 67%).
    • Grade 3/4 lymphopenia was associated with reduced OS (HR, 2.6; 95% CI, 1.3-5.5) in multivariate analysis.
  • Elevated neutrophil-to-lymphocyte ratio was associated with reduced RFS (HR, 3.3; 95% CI, 1.4-8.1 at 12 months) and OS (HR, 4.0; 95% CI, 1.6-10.0 at 12 months) in Kaplan-Meier analysis but was not included in multivariate analysis.
  • Postoperative RT was associated with improved OS (HR, 0.3; 95% CI, 0.1-0.6 vs definitive RT) in multivariate analysis.

Study design

  • 108 patients with HPV-negative OPC, 57 received postsurgical RT and 51 received definitive RT.
  • Funding: None disclosed.

Limitations

  • Retrospective, monocentric design.

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