{"doi":"10.1016/j.ctro.2021.02.011","title":"Prognosis of severe lymphopenia after postoperative radiotherapy in non-small cell lung cancer: Results of a long-term follow up study","abstract":"Purpose: To investigate the incidence and prognosis of severe radiation-induced lymphopenia (sRIL) after postoperative radiotherapy (PORT) for resected NSCLC. Patients and methods: Between 1998 and 2017, 170 patients treated with PORT for NSCLC were retrospectively reviewed. Lymphopenia was divided into tertiles with severe lymphopenia defined as absolute lymphocyte counts (ALC) < 0.37 10 3 /ul. Results: sRIL was observed in 32.3% of patients. Multivariable logistic regression analysis indicated sRIL was associated with planning target volume radiation fraction numbers (OR 1.09, p = 0.005) and total lung mean dose (OR 1.12, p = 0.006). With a median follow-up time of 12.2 years, the median progression-free survival and overall survival were 14.8 months and 28.4 months respectively in patients with sRIL, vs. 21.7 months (p = 0.008) and 48.3 months (p = 0.01) respectively in patients without sRIL. Multivariable analyses indicated sRIL significantly decreased OS (HR 1.95, p < 0.01). Since PORT for stage I-II NSCLC was done largely for positive margins, which may confound the contribution of severe RIL, we analyzed stage III separately and found that sRIL also significantly decreased OS (HR 1.88, p = 0.004) in multivariable analysis. Conclusion: For this long-term outcome study, severe RIL correlated with total lung mean dose and radiation fractionation numbers, and was a strong prognostic factor for poor survival in PORT patients, particularly in patients with stage III NSCLC, highlighting the importance of an intact immune system for post-radiation immunologic disease surveillance.","journal":"Clinical and Translational Radiation Oncology","year":2021,"id":192590,"datarank":0.37273599746820013,"base_score":2.4849066497880004,"endowment":2.4849066497880004,"self_citation_contribution":0.37273599746820013,"citation_network_contribution":0.0,"self_endowment_contribution":0.37273599746820013,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":11,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7345,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":759756,"name":"Yufei Liu","orcid":"0000-0003-3501-5790","position":1,"is_corresponding":false},{"id":759757,"name":"Hui Zhu","orcid":"0000-0003-3240-4934","position":2,"is_corresponding":false},{"id":236007,"name":"James W. Welsh","orcid":"0000-0002-2255-8502","position":3,"is_corresponding":false},{"id":397917,"name":"Saumil Gandhi","orcid":"0000-0002-3349-3521","position":4,"is_corresponding":false},{"id":283075,"name":"Melenda Jeter","orcid":"0000-0002-2792-0814","position":5,"is_corresponding":false},{"id":759758,"name":"Quynh Nguyen","orcid":"0000-0003-3225-5422","position":6,"is_corresponding":false},{"id":380275,"name":"Aileen B. Chen","orcid":"0000-0002-5385-3360","position":7,"is_corresponding":false},{"id":427356,"name":"Michael S. O’Reilly","orcid":null,"position":8,"is_corresponding":false},{"id":308376,"name":"Zhongxing Liao","orcid":"0000-0002-2224-9478","position":9,"is_corresponding":false},{"id":236018,"name":"Joe Y. Chang","orcid":"0000-0002-8435-2083","position":10,"is_corresponding":false},{"id":234976,"name":"Percy Lee","orcid":"0000-0001-6004-840X","position":11,"is_corresponding":false},{"id":236019,"name":"Steven H. Lin","orcid":"0000-0003-4411-0634","position":12,"is_corresponding":false},{"id":228165,"name":"Jing Wang","orcid":"0000-0002-5398-0802","position":0,"is_corresponding":true}],"reference_count":27,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:49:43.496702Z","pmid":"33778173","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}