PDF(Pubmed)
Abstract：
UNASSIGNED: Few studies concentrate on spleen dosimetry of radiotherapy for gastric cancer (GC). Although there is no consensus on the spleen dose-volume threshold for lymphopenia, several studies indicated that the higher the spleen dose, the higher the risk of lymphopenia. This study aimed to identify the appropriate spleen dosimetric parameters for predicting grade 4 + lymphopenia in patients with locally advanced GC.
UNASSIGNED: A total of 295 patients treated with nCRT and nChT from June 2013 to December 2021 at two major centers were included, of whom 220 were assigned to the training cohort and 75 to the external validation cohort.
UNASSIGNED: Grade 4 + lymphopenia was more common in the nCRT than in the nChT group (49.5% vs. 0, P < 0.001 in the training cohort; 25.0% vs. 0, P = 0.001 in the external validation cohort). Age ≥ 60 years (P = 0.006), lower pretreatment absolute lymphocyte count (P = 0.001), higher spleen volume (SPV) (P = 0.001), and higher V20 (P = 0.003) were significant risk factors of grade 4 + lymphopenia for patients treated with nCRT. Patients with grade 4 + lymphopenia had significantly worse PFS (P = 0.043) and showed a negative correlation trend with OS (P = 0.07). Limiting V20 to < 84.5% could decrease the incidence of grade 4 + lymphopenia by 35.7%. The predictive effectiveness of the multivariable model in the training and external validation cohorts was 0.880 and 0.737, respectively.
UNASSIGNED: Grade 4 + lymphopenia during nCRT was more common than nChT, and was associated with a worse PFS in GC patients. Constraining the spleen V20 to < 84.5% may indirectly improve outcomes through lymphocyte preservation.
UNASSIGNED: A total of 295 patients treated with nCRT and nChT from June 2013 to December 2021 at two major centers were included, of whom 220 were assigned to the training cohort and 75 to the external validation cohort.
UNASSIGNED: Grade 4 + lymphopenia was more common in the nCRT than in the nChT group (49.5% vs. 0, P < 0.001 in the training cohort; 25.0% vs. 0, P = 0.001 in the external validation cohort). Age ≥ 60 years (P = 0.006), lower pretreatment absolute lymphocyte count (P = 0.001), higher spleen volume (SPV) (P = 0.001), and higher V20 (P = 0.003) were significant risk factors of grade 4 + lymphopenia for patients treated with nCRT. Patients with grade 4 + lymphopenia had significantly worse PFS (P = 0.043) and showed a negative correlation trend with OS (P = 0.07). Limiting V20 to < 84.5% could decrease the incidence of grade 4 + lymphopenia by 35.7%. The predictive effectiveness of the multivariable model in the training and external validation cohorts was 0.880 and 0.737, respectively.
UNASSIGNED: Grade 4 + lymphopenia during nCRT was more common than nChT, and was associated with a worse PFS in GC patients. Constraining the spleen V20 to < 84.5% may indirectly improve outcomes through lymphocyte preservation.
摘要：
■很少有研究集中于胃癌（GC）放疗的脾剂量学。尽管对淋巴细胞减少的脾剂量-体积阈值尚无共识，几项研究表明，脾脏剂量越高，淋巴细胞减少的风险越高。本研究旨在确定合适的脾剂量学参数，以预测局部晚期GC患者的4级淋巴细胞减少。
■从2013年6月至2021年12月，在两个主要中心共纳入295名接受nCRT和nChT治疗的患者，其中220人被分配到训练队列,75人被分配到外部验证队列.
■4级+淋巴细胞减少在nCRT中比在nChT组中更常见（49.5%vs.0，训练队列中P<0.001；25.0%vs.0，外部验证队列中P=0.001）。年龄≥60岁（P=0.006），治疗前绝对淋巴细胞计数较低（P=0.001），较高的脾脏体积（SPV）（P=0.001），较高的V20(P=0.003)是nCRT治疗患者4级以上淋巴细胞减少的显著危险因素。4级以上淋巴细胞减少患者的PFS明显较差（P=0.043），与OS呈负相关趋势（P=0.07）。将V20限制在<84.5％可以将4级淋巴细胞减少症的发生率降低35.7％。多变量模型在训练和外部验证队列中的预测有效性分别为0.880和0.737。
■nCRT期间4级+淋巴细胞减少比nChT更常见，并与GC患者PFS恶化有关。将脾脏V20限制在<84.5％可能会通过淋巴细胞保存间接改善预后。
■从2013年6月至2021年12月，在两个主要中心共纳入295名接受nCRT和nChT治疗的患者，其中220人被分配到训练队列,75人被分配到外部验证队列.
■4级+淋巴细胞减少在nCRT中比在nChT组中更常见（49.5%vs.0，训练队列中P<0.001；25.0%vs.0，外部验证队列中P=0.001）。年龄≥60岁（P=0.006），治疗前绝对淋巴细胞计数较低（P=0.001），较高的脾脏体积（SPV）（P=0.001），较高的V20(P=0.003)是nCRT治疗患者4级以上淋巴细胞减少的显著危险因素。4级以上淋巴细胞减少患者的PFS明显较差（P=0.043），与OS呈负相关趋势（P=0.07）。将V20限制在<84.5％可以将4级淋巴细胞减少症的发生率降低35.7％。多变量模型在训练和外部验证队列中的预测有效性分别为0.880和0.737。
■nCRT期间4级+淋巴细胞减少比nChT更常见，并与GC患者PFS恶化有关。将脾脏V20限制在<84.5％可能会通过淋巴细胞保存间接改善预后。
