Lymphopenia and its association with survival in patients with locally advanced cervical cancer

Emily S. Wu*, Titilope Oduyebo, Lauren P. Cobb, Diana Cholakian, Xiangrong Kong, Amanda N. Fader, Kimberly L. Levinson, Edward James Tanner, Rebecca L. Stone, Anna Piotrowski, Stuart Grossman, Kara Long Roche

*Corresponding author for this work

Research output: Contribution to journalArticle

56 Scopus citations

Abstract

Objective To evaluate the association between lymphopenia and survival in women with cervical cancer treated with primary chemoradiation. Methods A single institution, retrospective analysis of patients with stage IB2-IVA cervical cancer who received upfront chemoradiation from 1998 to 2013 was performed. Complete blood counts from pre-treatment to 36 months post-treatment were analyzed. Lymphopenia and known prognostic factors were evaluated for an association with progression-free (PFS) and overall survival (OS). Results Seventy-one patients met study criteria for whom 47 (66%) had a documented total lymphocyte count (TLC) two months after initiating chemoradiation. FIGO stage distribution was 6% Stage I, 46% Stage II, 45% Stage III and 3% Stage IV. Pre-treatment TLC was abnormal (< 1000 cells/mm3) in 15% of patients. The mean reduction in TLC was 70% two months after initiating chemoradiation. Severe post-treatment lymphopenia (TLC < 500 cells/mm3) was observed in 53% of patients; they experienced inferior median OS (21.2 vs 45.0 months, P = 0.03) and similar 25th percentile PFS (6.3 vs 7.7 months, P = 0.06) compared to patients without severe lymphopenia. Multivariate analysis demonstrated pre-treatment TLC ≥ 1000 cells/mm3 and post-treatment TLC > 500 cells/mm3 had a 77% (HR: 0.23; 95%CI 0.05-1.03; P = 0.053) and 58% decrease in hazards of death (HR: 0.42; 95%CI 0.12-1.46; P = 0.17) respectively. Conclusion More than half of cervical cancer patients treated with chemoradiation experienced severe and prolonged lymphopenia. Although statistical significance was not reached, the findings suggest that pre- and post-treatment lymphopenia may be associated with decreased survival. Further research is warranted, given that lymphopenia could be a reversible prognostic factor.

Original languageEnglish (US)
Pages (from-to)76-82
Number of pages7
JournalGynecologic oncology
Volume140
Issue number1
DOIs
StatePublished - Jan 1 2016

Keywords

  • Cervical cancer
  • Chemoradiation
  • Lymphopenia

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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    Wu, E. S., Oduyebo, T., Cobb, L. P., Cholakian, D., Kong, X., Fader, A. N., Levinson, K. L., Tanner, E. J., Stone, R. L., Piotrowski, A., Grossman, S., & Long Roche, K. (2016). Lymphopenia and its association with survival in patients with locally advanced cervical cancer. Gynecologic oncology, 140(1), 76-82. https://doi.org/10.1016/j.ygyno.2015.11.013