Prognostic significance of post-treatment total lymphocyte count in locally advanced cervical cancer after definitive chemoradiotherapy

Abstract Background Studies evaluating the impact of lymphopenia after the completion of chemoradiotherapy on survival outcomes in patients with cervical cancer have been inconsistent, limited by small sample sizes, and rarely focused on post-treatment total lymphocyte count (TLC). Consequently, this study evaluated the association between post-treatment TLC and survival outcomes in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy. Methods We retrospectively reviewed the data of 298 patients with locally advanced cervical cancer who showed a definite complete response to concurrent chemoradiotherapy between January 2011 and December 2018. We obtained clinicopathological and TLC data at the end of treatment and at 1-year after treatment. The associations between TLC, overall survival (OS), and disease-free survival (DFS) were evaluated. Results Patients with post-treatment TLC ≥ 500 cells/mm 3 at the end of treatment tended to have better DFS and OS than those with post-treatment TLC < 500 cells/mm 3 , although the differences did not reach statistical significance ( p = 0.11 and 0.14, respectively). At the 1-year landmark, the OS and DFS rates were significantly higher in patients with post-treatment TLC ≥ 1000 cells/mm 3 than in those with TLC < 1000 cells/mm 3 (OS: 76.0% vs. 48.4%, p = 0.00026; DFS: 74.5% vs. 44.3%, p = 0.00034). Moreover, post-treatment TLC ≥ 1000 cells/mm 3 was identified as an independent favorable prognostic factor for OS and DFS in both univariate (HR 0.36, 95% CI 0.21–0.64, p < 0.001; and HR 0.37, 95% CI 0.21–0.65, p < 0.001, respectively) and multivariate analyses (HR 0.41, 95% CI 0.22–0.74, p = 0.003; and HR 0.42, 95% CI 0.23–0.76, p = 0.004, respectively). Conclusion While TLC at the end of treatment showed no significant association, persistent lymphopenia at 1-year post-treatment emerged as an independent poor prognostic factor for survival in locally advanced cervical cancer.