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    Pretreatment lymphocyte count predicts benefit from concurrent chemotherapy with radiotherapy in oropharyngeal cancer

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    Authors
    Price, James M
    Mistry, Hitesh
    Betts, G.
    Cheadle, Eleanor J
    Dixon, Lynne
    Garcez, Kate
    Illidge, Timothy M
    Iyizoba-Ebozue, Z.
    Lee, Lip W
    McPartlin, Andrew J
    Prestwich, R. J. D.
    Papageorgiou, S.
    Pritchard, D. J.
    Sykes, Andrew J
    West, Catharine M L
    Thomson, David J
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    Affiliation
    Department of Clinical Oncology, The Christie NHS Foundation Trust, Mancheste
    Issue Date
    2022
    
    Metadata
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    Abstract
    Purpose: There is a need to refine the selection of patients with oropharyngeal squamous cell carcinoma (OPSCC) for treatment de-escalation. We investigated whether pretreatment absolute lymphocyte count (ALC) predicted overall survival (OS) benefit from the addition of concurrent chemotherapy to radical radiotherapy. Patients and methods: This was an observational study of consecutive OPSCCs treated by curative-intent radiotherapy, with or without concurrent chemotherapy (n = 791) with external, independent validation from a separate institution (n = 609). The primary end point was OS at 5 years. Locoregional control (LRC) was assessed using competing risk regression as a secondary end point. Previously determined prognostic factors were used in a multivariable Cox proportional hazards model to assess the prognostic importance of ALC and the interaction between ALC and cisplatin chemotherapy use. Results: Pretreatment ALC was prognostic for 5-year OS on multivariable analysis (hazard ratio [HR] 0.64; 95% CI, 0.42 to 0.98; P = .04). It also predicted benefit from the use of concurrent cisplatin chemotherapy, with a significant interaction between cisplatin chemotherapy and pretreatment ALC (likelihood ratio test, P = .04): higher ALC count reduced the 5-year OS benefit compared with radiotherapy alone (HR 2.53; 95% CI, 1.03 to 6.19; P = .043). This was likely driven by an effect on LRC up to 5 years (interaction subdistribution HR 2.29; 95% CI, 0.68 to 7.71; P = .094). An independent validation cohort replicated the OS (HR 2.53; 95% CI, 0.98 to 6.52; P = .055) and LRC findings (interaction subdistribution HR 3.43; 95% CI, 1.23 to 9.52; P = .018). Conclusion: For OPSCC, the pretreatment ALC is prognostic for OS and also predicts benefit from the addition of cisplatin chemotherapy to radiotherapy. These findings require prospective evaluation, and could inform the selection of good prognosis patients for a de-escalation trial.
    Citation
    Price JM, Mistry HB, Betts G, Cheadle EJ, Dixon L, Garcez K, et al. Pretreatment Lymphocyte Count Predicts Benefit From Concurrent Chemotherapy With Radiotherapy in Oropharyngeal Cancer. Journal of Clinical Oncology. American Society of Clinical Oncology (ASCO); 2022.
    Journal
    Journal of Clinical Oncology
    URI
    http://hdl.handle.net/10541/625220
    DOI
    10.1200/jco.21.01991
    PubMed ID
    35385334
    Additional Links
    https://dx.doi.org/10.1200/jco.21.01991
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1200/jco.21.01991
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