Tumor-related leukocytosis is associated with poor radiation response and clinical outcome in uterine cervical cancer patients
Menée en Corée du Sud à partir de données portant sur 2 456 patientes atteintes d'un cancer du col de l'utérus de stade IA à IVA et ayant reçu entre 1986 et 2012 une radiothérapie en combinaison ou non avec une chimiothérapie à base de sels de platine (âge médian : 55 ans ; durée médiane de suivi : 65 mois), cette étude met en évidence une association entre la présence d'une leucocytose liée à la maladie et une faible réponse aux rayonnements ionisants ainsi qu'un pronostic défavorable
Background : To evaluate response to radiation and clinical outcome of uterine cervical cancer patients with tumor-related leukocytosis (TRL) at initial diagnosis and during definitive radiotherapy.
Patients and Methods : We retrospectively analyzed 2,456 patients with stage IA–IVA uterine cervical cancer who received definitive radiotherapy with (37.4%) or without (62.6%) platinum-based chemotherapy between 1986 and 2012. TRL was defined as two or more occurrences of leukocytosis over 9,000/
μL at the time of diagnosis and during the course of treatment. Locoregional failure-free survival (LFFS) and overall survival (OS) were compared between patients with or without TRL.
Results
:
The median age of all patients was 55 years and the median follow-up time was 65.1 months. TRL was observed in 398 patients (16%) at initial diagnosis; TRL (+) patients were younger and had larger tumors, advanced stage, and more frequent lymph node metastases (all p<0.05). TRL (+) patients showed a significantly lower rate of complete remission than TRL (-) patients (89.9% vs. 96.3% respectively, p=0.042). Ten-year LFFS and OS for all patients were 84% and 78%, respectively. LFFS and OS were significantly lower in TRL (+) patients than TRL (-) patients (10-year LFFS: 69% vs. 87% respectively, p<0.001; 10-year OS: 63% vs. 81% respectively p<0.001). After propensity score matching, LFFS and OS rates in TRL (+) patients remained significantly lower than for TRL (-) patients; this significant difference was also observed on multivariate analysis. Twenty-six percent of patients with locoregional failure (n=345) were TRL (+), and had significantly poorer median OS (6 vs. 12 months, p=0.001).
Conclusion
:
This study reveals the aggressive nature of cervical cancer with TRL, and its poor response to radiation therapy. Given the unfavorable prognosis and higher probability of treatment failure, optimal diagnostic and therapeutic approaches and careful monitoring for early detection of recurrence should be considered for these patients.
Annals of Oncology , résumé, 2016