Main Session
Sep
28
PQA 02 - Lung Cancer/Thoracic Malignancies, Patient Reported Outcomes/QoL/Survivorship, Pediatric Cancer
2521 - The Impact of Effective Dose to Immune Cells and Platelet-to-Lymphocyte Ratio on Lymphopenia and Prognosis in Patients with Unresectable Locally Advanced Non-Small Cell Lung Cancer
Presenter(s)
Haoting Yang, MD - Shandong Provincial Key Laboratory of Precision Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong
H. Yang1, J. Ma2, C. Tian1, J. Zhang3, S. Bao1, F. Wang1, J. Yu2, and D. Chen2; 1Shandong Provincial Key Laboratory of Precision Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China, 2Department of Radiation Oncology and Shandong Provincial Key Laboratory of Precision Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China, 3Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
Purpose/Objective(s):
The effective dose to immune cells (EDIC) is associated with grade = 3 radiation-induced lymphopenia (RIL3+) and prognosis in patients with unresectable locally advanced non-small cell lung cancer (LA-NSCLC). However, the predictive ability of EDIC alone is limited and the combination of peripheral blood inflammatory indicators (PBIIs) is expected to improve the predictive ability. The predictive value of PBIIs, such as platelet-to-lymphocyte ratio (PLR), remains to be explored. We investigated the impact of EDIC and pre-radiotherapy PLR on RIL3+ and prognosis in patients with unresectable LA-NSCLC.Materials/Methods:
We enrolled 139 patients with unresectable LA-NSCLC patients receiving chemoradiotherapy and consolidation immunotherapy. The primary endpoint was RIL3+. The secondary endpoints were progression-free survival (PFS) and overall survival (OS). Logistic regression was used to identify the predictors of RIL3+. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-offs. Each indicator was then assigned a point of 0 or 1 based on the cut-off. A point of 0 was given for a value below the cut-off, and a point of 1 for not less than the cut-off. The sum of the points for each indicator yielded a total score of 0, 1, or 2, which divided patients into a low-risk group (total score = 0 or 1) and a high-risk group (total score = 2). Cox proportional hazards regression was used to determine prognostic factors for PFS and OS.Results:
EDIC (odds ratio [OR] = 2.78; P = 0.001) and PLR (OR = 1.02; P < 0.001) were both significantly associated with RIL3+. The combination of EDIC and PLR (area under the curve [AUC] = 0.776) outperformed the prediction models using EDIC alone (AUC = 0.685; P = 0.027) and PLR alone (AUC = 0.667; P = 0.020). The optimal cut-offs of EDIC and PLR were 1.58 Gy and 107.70, respectively. The incidence rates of RIL3+ in the low- and high-risk groups were 44.3% and 90.0%, respectively (P < 0.001). Compared to the high-risk group, patients in the low-risk group had a longer median PFS (hazard ratio [HR] = 0.58; P = 0.011) and OS (HR = 0.50; P = 0.013).Conclusion:
The combination of EDIC and PLR is a better predictor of RIL3+ and prognosis in patients with unresectable LA-NSCLC. Reducing EDIC and considering PLR before radiotherapy may potentially avoid RIL3+ and improve prognosis.