Main Session
Sep
30
PQA 08 - Gastrointestinal Cancer, Nonmalignant Disease, Palliative Care
3561 - The Predictive Value of Pretreatment Peripheral T-Lymphocyte Subsets for Therapeutic Efficacy in Esophageal Squamous Cell Carcinoma Patients Undergoing Neoadjuvant Chemoradiotherapy: A Prospective Cohort Analysis
Presenter(s)
Wei-Xiang Qi, MD, RT - Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, Shanghai
M. Wang1, W. X. Qi1, H. Zhao1, X. Yang2, S. Li1, H. Li1, J. Chen1, and S. Zhao1; 1Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China, 2People's Hospital of Qiandongnan Miao and Dong Autonomous Prefecture, Kaili, Guizhou, China
Purpose/Objective(s):
Neoadjuvant chemoradiotherapy (NCRT) combined with esophagectomy is the recommended treatment for locally advanced esophageal squamous cell carcinoma (ESCC); however, not all patients benefit from NCRT, and predictive biomarkers remain lacking. This study aims to analyze the association between pretreatment peripheral blood T-lymphocyte subsets and response to NCRT.Materials/Methods:
This study enrolled patients with ESCC who received neoadjuvant chemoradiotherapy with or without immunotherapy followed by esophagectomy between April 2018 and November 2024, as part of a prospective cohort analysis. Clinical variables and T-lymphocyte subsets ( the absolute counts of CD3+, CD4+ and CD8+ T cells[cells/µL], CD3+[%], CD3+CD4+[%], CD3+CD8+[%], CD4+/CD8+) were collected prior to NCRT. Univariate and multivariate analyses were performed to identify independent predictors of treatment response in ESCC.Results:
A total of 212 patients were included. Of these, 150 (70.8%) patients achieved better tumor regression grade (TRG0/1) and pathological complete response (pCR) rate was 42.5%. Prior to NCRT, the absolute CD4+T cell counts were significantly higher in the TRG 0/1 group compared to the TRG 2/3 group (P = 0.022). Univariate analysis revealed that body mass index (BMI) >24 kg/m², CD4+ T cell counts >474 cells/µL, CD3+T cell counts >1264 cells/µL, and CD3+CD4+ >44% were associated with TRG 0/1. Multivariate logistic regression analysis identified CD4+ T cell counts (odds ratio [OR] = 2.146, 95% confidence interval [CI]= 1.157-3.982, P = 0.015) and BMI (OR = 2.097, 95% CI = 1.017-4.323, P = 0.045) as two independent predictors of TRG0/1. The C-index of the multivariate model was 0.623 (95% CI = 0.543-0.702). Furthermore, after adjusting for BMI, elevated CD3+ T cell counts were also associated with an improved rate of pCR (OR = 2.429, 95% CI = 1.264-4.668, P = 0.008).Conclusion:
Higher pretreatment absolute CD4+T cell counts are an independent protective factor for achieving favorable treatment outcomes in ESCC patients undergoing NCRT. Therefore, monitoring T-lymphocyte subsets prior to NCRT may help predict treatment response and advance personalized cancer therapy.