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Prognostic impact of neutrophilia and lymphopenia on survival in anal cancer treated with definitive concurrent chemoradiotherapy: a retrospective multicenter study

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Abstract

Purpose

This study evaluated the prognostic value of leukocyte, lymphocyte, and neutrophil counts in anal cancer patients undergoing concurrent chemoradiotherapy (CCRT).

Methods

Multi-institutional retrospective data review included 148 non-metastatic anal cancer patients treated with definitive CCRT with 5-fluorouracil plus mitomycin C between the year 2001 and 2019. The median radiation dose to the primary tumor was 54 Gy with a median pelvic dose of 45 Gy. Median follow-up duration was 56 months, and complete blood cell counts were analyzed from baseline to 1 year after the completion of radiotherapy.

Results

Although most patients showed a normal number of blood cells before treatment, 6.1% and 4.1% of patients showed leukocytosis (> 10,000/μl) and neutrophilia (> 7500/μl), respectively. After the initiation of treatment, seven patients (4.7%) displayed grade 4 lymphopenia (< 200/μl) at 1 month. Patients with initial leukocytosis showed inferior progression- and locoregional progression-free survival, and neutrophilia was a prognostic factor in all survival outcomes. Grade 4 lymphopenia at 1 month was also significantly associated with overall, progression-, and distant metastasis-free survival. On multivariate analyses, baseline neutrophilia was associated with 56.8-, 22.6-, 10.7-, and 23.0-fold increased risks of death, disease relapse, locoregional progression, and distant metastasis, respectively. Furthermore, lymphocytes < 200/μl at 1 month was linked to 6.8-, 5.4-, and 6.3-fold increased risks for death, disease relapse, and distant metastasis, respectively.

Conclusion

The number of leukocytes, lymphocytes, and neutrophils readily acquired from routine blood tests before and during treatment could be an independent prognostic factor of survival in patients with anal cancer.

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Code availability

SPSS v. 23.0 (SPSS, Inc., Chicago, IL, USA) was used.

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Funding

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Author notes

  1. Eunji Kim and Tae Hyung Kim have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea

    Eunji Kim, Won Il Jang & Mi-Sook Kim

  2. Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea

    Tae Hyung Kim, Kyung Hwan Kim, Jee Suk Chang & Woong Sub Koom

  3. Department of Radiation Oncology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea

    Tae Hyung Kim

  4. Department of Radiation Oncology, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Korea

    Wonguen Jung & Kyubo Kim

  5. Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea

    Ah Ram Chang

  6. Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Korea

    Hae Jin Park

  7. Department of Radiation Oncology, Konkuk University School of Medicine, Seoul, Korea

    Hyeon Kang Koh & Semie Hong

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  1. Eunji Kim
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Contributions

This study was designed by EK and KK. EK, THK, WJ, KK, ARC, HJP, HKK, SH, KHK, JSC, WSK, WIJ, and MSK contributed to the data collection and analysis. The manuscript was written by EK and KK, and reviewed by all authors.

Corresponding author

Correspondence to Kyubo Kim.

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Conflict of interest relevant to this study was not reported.

Ethical approval and consent to participate

The institutional review board approved this study from each institution, and the written consents were waived.

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All authors agreed to publication.

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Kim, E., Kim, T.H., Jung, W. et al. Prognostic impact of neutrophilia and lymphopenia on survival in anal cancer treated with definitive concurrent chemoradiotherapy: a retrospective multicenter study. Int J Clin Oncol 27, 553–562 (2022). https://doi.org/10.1007/s10147-021-02094-5

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  • DOI: https://doi.org/10.1007/s10147-021-02094-5

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