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Tuesday, October 12, 2021

Identifying distinct risks of treatment failure in nasopharyngeal carcinoma: A study based on the dynamic changes in peripheral blood lymphocytes, monocytes, N classification, and plasma Epstein‐Barr virus DNA

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Abstract

Background

To evaluate the prognostic value of the dynamic change in absolute lymphocyte counts (ALCs) and absolute monocyte counts (AMCs) and identify patients with N stage and plasma Epstein-Barr virus (EBV) DNA levels in nasopharyngeal carcinoma (NPC) who are at risk of treatment failure.

Methods

A total of 1124 eligible patients with Stage II–IVb NPC treated with concurrent chemoradiotherapy (CCRT) were enrolled. Percentage changes in the ALC (Ī”ALC%) and AMC (Ī”AMC%) were calculated.

Results

Patients with high Ī”ALC% were correlated with poorer 5-year overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) rates than those with low Ī”ALC%. Likewise, high Ī”AMC% was significantly associated with worse outcome than low Ī”AMC% (OS, p = 0.001; PFS, p = 0.001; DMFS, p = 0.034). Multivariate analyses revealed that Ī”ALC% (p = 0.046), Ī”AMC% (p = 0.019), and EBV DNA level (p < 0.001) were independent prognostic factors for OS. With respect to PFS, Ī”ALC% (p = 0.036), Ī”AMC% (p = 0.011), N classification (p = 0.016), and EBV DNA level (p < 0.001) were also independent prognosticators. Based on the aforementioned independent risk factors (Ī”ALC% ≥ 83.33%, Ī”AMC% ≥ 40.00%, Stage N2–3, EBV DNA ≥ 4000 copies/ml), patients were divided into three differen t risk groups (low-risk group [with <1 risk factor], intermediate risk group [with 1–3 risk factors], and high-risk group [with 4 risk factors]) that correlated with disparate risks of death (p < 0.001), disease progression (p < 0.001), and distant metastasis (p < 0.001).

Conclusions

High Ī”ALC% and Ī”AMC% were correlated with poor prognosis in patients with NPC. Risk stratification based on Ī”ALC%, Ī”AMC%, N classification, and plasma EBV DNA levels could provide potential utility for risk-adapted therapeutic strategies for NPC.

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