{"doi":"10.21037/jgo-21-323","title":"Prognostic impact of lymphopenia and neutrophil-lymphocyte ratio for patients with anal squamous cell carcinoma","abstract":"BACKGROUND: Outcomes after definitive chemoradiation for squamous cell carcinoma are generally favorable. However, biomarkers to further yield prognostic information are desired. Treatment-related lymphopenia as well as an elevated baseline neutrophil-lymphocyte ratio have been associated with worse survival in several cancer types. We evaluated absolute lymphocyte count and neutrophil-lymphocyte ratio at baseline and at treatment-related nadir in patients with anal cancer for associations with oncologic endpoints. METHODS: We conducted a retrospective analysis of 428 consecutive patients with non-metastatic anal cancer treated with definitive, intensity-modulated radiation therapy-based chemoradiation. We analyzed absolute neutrophil and lymphocyte counts at several timepoints: pretreatment, weekly during treatment, and in the six weeks following treatment completion. Neutrophil-lymphocyte ratio was calculated at baseline and treatment-related nadir. We estimated oncologic endpoints using life tables and compared them using the log-rank test. We conducted univariate and multivariable time-to-event analyses using Cox proportional hazards. RESULTS: Median absolute lymphocyte count at baseline and nadir were 1.80 [interquartile range (IQR), 1.45-2.32] k/µL and 0.26 (IQR, 0.18-0.36) k/µL, respectively, and 31% developed treatment-related grade 4 lymphopenia. Median neutrophil-lymphocyte ratio at baseline and nadir were 2.34 (IQR, 1.68-3.30) and 8.80 (IQR, 5.86-12.68), respectively. Estimates of overall survival, local failure-free survival, distant metastasis-free survival (DMFS), and freedom from colostomy at 5 years were 87%, 86%, 82%, and 88%, respectively. Baseline and nadir absolute lymphocyte count were not associated with selected outcomes on univariate analysis. On multivariable analysis, factors independently associated with death included T3-T4 disease, HIV-positive status, treatment break, and baseline neutrophil-lymphocyte ratio >3. Baseline neutrophil-lymphocyte ratio showed a trend toward association with distant progression or death (P=0.07). The 5-year overall survival estimates for patients with baseline neutrophil-lymphocyte ratios ≤3 and >3 were 92.3% and 80.6%, respectively. CONCLUSIONS: Lymphopenia during and after chemoradiation for anal cancer is common but does not appear to be associated with worse survival, recurrence, or metastases. However, elevated baseline neutrophil-lymphocyte ratio was independently associated with overall survival, local recurrence-free survival, and DMFS. Further studies are needed to determine the clinical utility of baseline neutrophil-lymphocyte ratio to guide treatment and follow-up.","journal":"Journal of Gastrointestinal Oncology","year":2021,"id":183025,"datarank":0.40620753016533157,"base_score":2.70805020110221,"endowment":2.70805020110221,"self_citation_contribution":0.40620753016533157,"citation_network_contribution":0.0,"self_endowment_contribution":0.40620753016533157,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":14,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9616,"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":355311,"name":"Ethan B. Ludmir","orcid":"0000-0002-5472-5344","position":1,"is_corresponding":false},{"id":705327,"name":"Craig Messick","orcid":"0000-0003-0714-5037","position":2,"is_corresponding":false},{"id":736094,"name":"Matthew Cagley","orcid":"0000-0002-1595-1699","position":3,"is_corresponding":false},{"id":461072,"name":"Van K. Morris","orcid":"0000-0002-4911-2252","position":4,"is_corresponding":false},{"id":341838,"name":"Prajnan Das","orcid":"0000-0002-3845-0707","position":5,"is_corresponding":false},{"id":72433,"name":"Bruce D. Minsky","orcid":"0000-0001-8434-7930","position":6,"is_corresponding":false},{"id":60605,"name":"Cullen M. Taniguchi","orcid":"0000-0002-8052-3316","position":7,"is_corresponding":false},{"id":380273,"name":"Grace L. Smith","orcid":"0000-0002-3171-2911","position":8,"is_corresponding":false},{"id":227744,"name":"Eugene J. Koay","orcid":"0000-0001-7675-3461","position":9,"is_corresponding":false},{"id":254922,"name":"Albert C. Koong","orcid":"0000-0001-9824-1643","position":10,"is_corresponding":false},{"id":409471,"name":"Radhe Mohan","orcid":"0000-0003-3746-4557","position":11,"is_corresponding":false},{"id":428202,"name":"Emma B. Holliday","orcid":"0000-0002-4362-461X","position":12,"is_corresponding":false},{"id":512279,"name":"Brian De","orcid":"0000-0003-3468-3359","position":0,"is_corresponding":true}],"reference_count":37,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:48:17.816498Z","pmid":"34790402","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":[]}