Lymphocytes play a critical role in the host immune system, and a decrease in number of lymphocytes, caused by malnutritional status and chemoradiotherapy (CRT) leads to immunosuppression. Immunosuppression could enhance the cancer development and progression. Previous studies demonstrated that lymphopenia was associated with worse prognosis in the pancreatic, lung, head and neck, and rectal cancer, but little is known about esophageal cancer. Methods There were 298 patients of esophageal malignant tumors, who had been initially treated with chemoradiotherapy (CRT) between January, 2007 and December, 2018. The total lymphocyte counts (TLC) before CRT and the nadir value during 6 weeks after CRT along with other clinical and treatment characteristics of these 298 patients, were retrospectively evaluated in relevance with the overall survival (OS) after CRT. Results The median TLC before and after CRT were 1469 (range 456–4710)/mm3 and 354 (range 21–1500)/mm3, respectively. When the patients were stratified with the threshold value of 1500/mm3 of pretreatment TLC, the Log-Rank test showed significant difference in OS between these 2 groups (OS 48.7% vs 36.6%, p = 0.011). In addition, the CTCAE grade of lymphopenia exceeding 3 after CRT was associated with worse OS even in the group with pretreatment TLC level more than 1500/mm3. The multivariate analysis showed that the significant prognostic factors of OS were cN, cM, additional esophagectomy and pretreatment TLC. Conclusion The decease of pretreatment TLC was significantly associated with worse OS when the patients of esophageal cancer were initially treated with CRT.

中文翻译：

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100 个总淋巴细胞计数 (TLC) 预测食管癌患者放化疗后的总体生存率

淋巴细胞在宿主免疫系统中起关键作用，由营养不良和放化疗 (CRT) 引起的淋巴细胞数量减少会导致免疫抑制。免疫抑制可以促进癌症的发展和进展。先前的研究表明，淋巴细胞减少与胰腺癌、肺癌、头颈癌和直肠癌的预后较差有关，但对食管癌知之甚少。方法 2007 年 1 月至 2018 年 12 月期间接受过放化疗（CRT）初始治疗的食管恶性肿瘤患者 298 例。这 298 例患者的临床和治疗特征，回顾性评估与 CRT 后总生存期 (OS) 的相关性。结果 CRT 前后的中位 TLC 分别为 1469（范围 456-4710）/mm3 和 354（范围 21-1500）/mm3。当患者以治疗前 TLC 的阈值 1500/mm3 进行分层时，Log-Rank 检验显示这两组的 OS 存在显着差异（OS 48.7% vs 36.6%，p = 0.011）。此外，即使在治疗前 TLC 水平超过 1500/mm3 的组中，CRT 后淋巴细胞减少超过 3 级的 CTCAE 分级与较差的 OS 相关。多因素分析显示，影响OS的显着预后因素为cN、cM、附加食管切除术和治疗前TLC。