Study Of The Relationship Between Peripheral Blood Cell Parameters And Prognosis Of Intensity Modulated Radiotherapy For Esophageal Carcinoma

Objective:The aim of this study is that to find simple and effective hematological immune indicators parameters which can predict the long-term survival of patient of esophageal carcinoma(EC)with radiotherapy by observing a series of changes of peripheral blood cell count before,during,and at the end of treatment with radiotherapy for EC patients.Methods:From January 2013 to December 2015,248 patients of esophageal carcinoma treated by definitive radiotherapy with weekly complete peripheral blood cell count taken during the treatment period and were analyzed.Register and record absolute number of neutrophil,lymphocyte,monocyte and platelet count,and calculate the neutrophil-to-1ymphocyte ratio(NLR),the platelet-to-lymphocyte ratio(PLR),the lymphocyte-to-monocyte ratio(LMR).The grade standard of absolute lymphocyte count(ALC)nadir during radiotherapy period based on CTCAE v5.0 and others'standards classification of blood cells based on the median value.Software SPSS 22.0for statistical analysis.Results:The follow-up time was cut off at the end of 2017 with 2patients lost and the follow-up rate was 99.2%.The 1-year,2-year,3-year overall survival rates of all patients were 75.0%,48.8%,35.7%,respectively.The progression-free survival rates were 55.6%?34.6%?26.1%,respectively.The local control rates were 71.0%,57.4%,47.1%,respectively.The distant metastases-free rates were 85.0%,70.4%,59.9%,respectively.The univariate analysis showed that the absolute mononuclear cell count(AMC)maximum value,AMC average value and LMR average value were the significant influence factors to overall survival.The AMC average value and LMR average value were the significant influence factors to progression-free survival,and the AMC maximum value(?~2=3.410,P=0.065)was closed to the statistical significance.The AMC value of before treatment and AMC average value were the clearly influencing factors of local control,and the AMC maximum value(?~2=3.390,P=0.066)and the LMR average value(?~2=3.372,P=0.053)were closed to the statistical significance.The multivariate analysis revealed that the AMC average value was the effect factor of overall survival,progression-free survival and local control.Difference gender has a clearly different numerical value on the AMC average value,maximum value,and the AMC value before radiotherapy.ALC displayed an exponential decline while AMC putting up a slowly rising during radiotherapy.The patients with concurrent radio-chemotherapy when the AMC average was lower(?~2=4.240,P=0.039)had a longer overall survival by stratified analysis.No significant correlations were found between various peripheral blood cells parameters and recently effects,radioactive esophagitis and radioactive pneumonitis.Conclusions:1.Preliminary study result showed that absolute mononuclear cell count rose slowly during radiotherapy period and higher value of absolute mononuclear cell count was significantly associated with poor treatment outcomes.2.Gender may be one of affect factors of absolute mononuclear cell count and it needed to be studied further.3.No significant effect was found between the decrease of peripheral blood absolute lymphocyte count and prognosis in patients with esophageal cancer during radiotherapy.