Gastrointestinal Cancer

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SU_11_2110 - Lack of validation of lymphopenia as a prognostic factor in esophageal cancer chemoradiation

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Lack of validation of lymphopenia as a prognostic factor in esophageal cancer chemoradiation
M. Zhang, P. Oh, P. Brady, D. H. Ilson, Y. Janjigian, G. Ku, C. H. Crane, A. Jackson, and A. J. Wu; Memorial Sloan Kettering Cancer Center, New York, NY

Purpose/Objective(s): Chemoradiation is used as both a neoadjuvant and definitive treatment for localized esophageal cancer. Recent data has suggested a significant and independent association between overall survival and severe lymphopenia. Here we evaluate the association between severe (grade 4) lymphopenia during chemoradiation as a predictor of survival in an independent cohort, and whether it is influenced by choice of chemotherapy agent.

Materials/Methods: We reviewed 395 consecutive patients with stage I-III esophageal cancer treated with definitive or preoperative chemoradiation (mostly IMRT) between 2007 and 2015 at our center. Chemotherapy agents as well as complete blood counts during both induction chemotherapy and concurrent chemoradiation were extracted for analysis. Overall, 95% of the patients received induction chemotherapy. All patients received concurrent chemotherapy: 56% received platinum/taxane, 20% received platinum/5-FU, 0.8% received taxane/5-FU, and 23% received other agents. Other clinical covariates (surgery, gender, stage, and histology) were recorded. Grade 4 lymphopenia was defined by CTAE 4.0. Kaplan-Meier survival and a log-rank test were used to analyze the association of these factors with overall survival.

Results: The development of grade 4 lymphopenia (134 of 395 patients) during concurrent chemoradiation was not predictive of 5-year overall survival in the full cohort of patients (34% vs. 41%, p = 0.47). Grade 4 lymphopenia was also not predictive of survival in sub-groups stratified by surgery, gender, stage, or histology. However, a significant association was observed in the subset of patients who received concurrent platinum/5-FU chemotherapy, where patients who developed grade 4 lymphopenia (19 of 80 patients) had significantly lower overall survival (0% vs. 28%, p<0.0001). No such association was seen when looking at other concurrent chemotherapy regimens, including platinum/taxane-based chemotherapy (86 of 220 patients, 41% vs. 47%, p=0.64) and all other chemotherapy regimens (28 of 92 patients, 39% vs 41%, p=0.83).

Conclusion: In contrast to a previous report, we did not observe a significant relationship between grade 4 lymphopenia during chemoradiation and overall survival. The reasons for the lack of validation of the impact of lymphopenia in our patient population is unclear, but could relate to differences in radiation dose distributions and modality, increased use of induction chemotherapy, and different distribution of concurrent chemotherapy agents. However, we did observe a significant association with lymphopenia among patients who received platinum/5-FU-based concurrent chemotherapy. These data indicate a need for further study of relationship between grade 4 lymphopenia and outcome after chemoradiation for esophageal cancer, the underlying reasons that lymphopenia may be associated with survival, and whether the impact of lymphopenia depends upon the type of chemotherapy used concurrently with radiation.

Author Disclosure: M. Zhang: Employee; SUNY Downstate Medical Center. P. Oh: None. P. Brady: None. D.H. Ilson: None. Y. Janjigian: None. A. Jackson: Employee; Memorial Sloan Kettering Cancer Center. Research Grant; NCI. A.J. Wu: None.

Minsi Zhang, MD

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SU_11_2110 - Lack of validation of lymphopenia as a prognostic factor in esophageal cancer chemoradiation



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