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Abstract
Purpose: This study evaluated the prognostic value of leukocyte, lymphocyte, and neutrophil counts in anal cancer patients undergoing concurrent chemoradiotherapy (CCRT).

Methods: Multi-institutional retrospective data review included 148 non-metastatic anal cancer patients treated with definitive CCRT with 5-fluorouracil plus mitomycin C between the year 2001 and 2019. The median radiation dose to the primary tumor was 54 Gy with a median pelvic dose of 45 Gy. Median follow-up duration was 56 months, and complete blood cell counts were analyzed from baseline to 1 year after the completion of radiotherapy.

Results: Although most patients showed a normal number of blood cells before treatment, 6.1% and 4.1% of patients showed leukocytosis (> 10,000/μl) and neutrophilia (> 7500/μl), respectively. After the initiation of treatment, seven patients (4.7%) displayed grade 4 lymphopenia (< 200/μl) at 1 month. Patients with initial leukocytosis showed inferior progression- and locoregional progression-free survival, and neutrophilia was a prognostic factor in all survival outcomes. Grade 4 lymphopenia at 1 month was also significantly associated with overall, progression-, and distant metastasis-free survival. On multivariate analyses, baseline neutrophilia was associated with 56.8-, 22.6-, 10.7-, and 23.0-fold increased risks of death, disease relapse, locoregional progression, and distant metastasis, respectively. Furthermore, lymphocytes < 200/μl at 1 month was linked to 6.8-, 5.4-, and 6.3-fold increased risks for death, disease relapse, and distant metastasis, respectively.

Conclusion: The number of leukocytes, lymphocytes, and neutrophils readily acquired from routine blood tests before and during treatment could be an independent prognostic factor of survival in patients with anal cancer.

Affiliations

Eunji Kim #  1 , Tae Hyung Kim #  2   3 , Wonguen Jung  4 , Kyubo Kim  5 , Ah Ram Chang  6 , Hae Jin Park  7 , Hyeon Kang Koh  8 , Semie Hong  8 , Kyung Hwan Kim  2 , Jee Suk Chang  2 , Woong Sub Koom  2 , Won Il Jang  1 , Mi-Sook Kim  1
1 Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
2 Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
3 Department of Radiation Oncology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea.
4 Department of Radiation Oncology, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Korea.
5 Department of Radiation Oncology, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Korea. kyubokim.ro@gmail.com.
6 Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
7 Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Korea.
8 Department of Radiation Oncology, Konkuk University School of Medicine, Seoul, Korea.
# Contributed equally.