title: Minimum absolute lymphocyte counts during radiation are associated with a worse prognosis in patients with unresectable hepatocellular carcinoma.
abstract: BACKGROUND
  Peripheral blood lymphocytes play an important role in antitumour immunity. We examined the relationship between the minimum absolute lymphocyte counts (Min ALCs) during radiotherapy (RT) and clinical outcomes in patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  Data from a total of 69 HCC patients who had received RT were retrospectively analysed. Peripheral blood lymphocytes were measured before RT, weekly during RT and after RT. Regression and mixed-effect models were used to assess the relationships with and potential predictors of overall survival (OS). Receiver-operating characteristic (ROC) curve analysis was used to define optimal cut-off points of continuous variables for outcomes.
  
  
  RESULTS
  The median follow up was 30 months (range, 4-68 months). The median survival time (MST), 1-year OS rate and 2-year OS rate of the whole group were 25 months, 51% and 39%, respectively. The average circulating lymphocyte counts declined during RT (1493.19versus503.48 cells/µl,p< 0.001). A lower Min ALC was associated with worse OS (p= 0.001), with a cut-off value of 450 cells/µl (sensitivity and specificity, 50% and 70.6%, respectively). The MSTs, 1-year OS rates and 2-year OS rates were 15 monthsversus47 months, 27%versus78% and 4%versus71% for patients with relatively lower (⩽450 cells/µl) and higher Min ALCs (>450 cells/µl), respectively (p< 0.001). After adjusting for potential confounders, multivariate Cox regression analysis demonstrated that Min ALC independently predicted patients' OS (HR, 0.32; 95% CI, 0.15-0.69).
  
  
  CONCLUSIONS
  Lower Min ALCs during RT may act as a worse prognostic factor for HCC after RT.
authors.affiliation: School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong Province, People's Republic of China Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China.
authors.forename: Qianqian
authors.initials: Q
authors.lastname: Zhao
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China.
authors.forename: Xiaoqing
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China.
authors.forename: Jinbo
authors.initials: J
authors.lastname: Yue
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China.
authors.forename: Kunli
authors.initials: K
authors.lastname: Zhu
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China.
authors.forename: Rui
authors.initials: R
authors.lastname: Feng
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China.
authors.forename: Shumei
authors.initials: S
authors.lastname: Jiang
authors.affiliation: School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong Province, People's Republic of China Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China.
authors.forename: Zhonghua
authors.initials: Z
authors.lastname: Qi
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, No.440 Jinyan Road, Huaiyin District, Jinan City, Shandong Province, People's Republic of China.
authors.forename: Renben
authors.initials: R
authors.lastname: Wang
keywords: clinical outcomes; hepatocellular carcinoma; minimum absolute lymphocyte counts; prognostic; radiotherapy