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Perioperative Lymphopenia is Associated with Increased Risk of Recurrence and Worse Survival Following Hepatectomy for Hepatocellular Carcinoma
Introduction Immune dysregulation may be associated with cancer progression. We sought to investigate the prognostic value of perioperative lymphopenia on short- and long-term outcomes among patients undergoing resection of hepatocellular carcinoma (HCC). Methods Patients undergoing resection of HCC...
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| Published in: | Annals of surgical oncology 2024-04, Vol.31 (4), p.2568-2578 |
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| creator | Tsilimigras, Diamantis I. Endo, Yutaka Ratti, Francesca Marques, Hugo P. Cauchy, François Lam, Vincent Poultsides, George A. Popescu, Irinel Alexandrescu, Sorin Martel, Guillaume Kitago, Minoru Guglielmi, Alfredo Hugh, Tom Aldrighetti, Luca Gleisner, Ana Shen, Feng Endo, Itaru Pawlik, Timothy M. |
| description | Introduction
Immune dysregulation may be associated with cancer progression. We sought to investigate the prognostic value of perioperative lymphopenia on short- and long-term outcomes among patients undergoing resection of hepatocellular carcinoma (HCC).
Methods
Patients undergoing resection of HCC between 2000 and 2020 were identified using an international database. The incidence and impact of perioperative lymphopenia [preoperative, postoperative day (POD) 1/3/5], defined as absolute lymphocyte count (ALC) |
| doi_str_mv | 10.1245/s10434-023-14811-7 |
| format | article |
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Immune dysregulation may be associated with cancer progression. We sought to investigate the prognostic value of perioperative lymphopenia on short- and long-term outcomes among patients undergoing resection of hepatocellular carcinoma (HCC).
Methods
Patients undergoing resection of HCC between 2000 and 2020 were identified using an international database. The incidence and impact of perioperative lymphopenia [preoperative, postoperative day (POD) 1/3/5], defined as absolute lymphocyte count (ALC) <1000/μL, on short- and long-term outcomes was assessed.
Results
Among 1448 patients, median preoperative ALC was 1593/μL [interquartile range (IQR) 1208–2006]. The incidence of preoperative lymphopenia was 14.0%, and 50.2%, 45.1% and 35.6% on POD1, POD3 and POD5, respectively. Preoperative lymphopenia predicted 5-year overall survival (OS) [lymphopenia vs. no lymphopenia: 49.1% vs. 66.1%] and 5-year disease-free survival (DFS) [25.0% vs. 41.5%] (both
p
< 0.05). Lymphopenia on POD1 (5-year OS: 57.1% vs. 71.2%; 5-year DFS: 30.0% vs. 41.1%), POD3 (5-year OS: 57.3% vs. 68.9%; 5-year DFS: 35.4% vs. 42.7%), and POD5 (5-year OS: 53.1% vs. 66.1%; 5-year DFS: 32.8% vs. 42.3%) was associated with worse long-term outcomes (all
p
< 0.05). Patients with severe lymphopenia (ALC <500/μL) on POD5 had worse 5-year OS and DFS (5-year OS: 44.7% vs. 54.3% vs. 66.1%; 5-year DFS: 27.8% vs. 33.3% vs. 42.3%) [both
p
< 0.05], as well as higher incidence of overall (45.5% vs. 25.3% vs. 30.9%;
p
= 0.013) and major complications (18.2% vs. 3.4% vs. 4.5%;
p
< 0.001) versus individuals with moderate (ALC 500–1000/μL) or no lymphopenia following hepatectomy for HCC. After adjusting for competing risk factors, prolonged lymphopenia was independently associated with higher hazards of death [hazard ratio (HR) 1.38, 95% CI 1.11–1.72] and recurrence (HR 1.22, 95% CI 1.02–1.45).
Conclusion
Perioperative lymphopenia had short- and long-term prognostic implications among individuals undergoing hepatectomy for HCC.]]></description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-023-14811-7</identifier><identifier>PMID: 38180707</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Cell number ; Hepatectomy ; Hepatobiliary Tumors ; Hepatocellular carcinoma ; Liver cancer ; Lymphocytes ; Lymphopenia ; Medicine ; Medicine & Public Health ; Oncology ; Risk factors ; Surgery ; Surgical Oncology</subject><ispartof>Annals of surgical oncology, 2024-04, Vol.31 (4), p.2568-2578</ispartof><rights>Society of Surgical Oncology 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. Society of Surgical Oncology.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-dab5c77e710e0f9a0b1d4481cfa746430b64ec426eabb267e1a4650a95ca23583</citedby><cites>FETCH-LOGICAL-c375t-dab5c77e710e0f9a0b1d4481cfa746430b64ec426eabb267e1a4650a95ca23583</cites><orcidid>0000-0002-7994-9870</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38180707$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tsilimigras, Diamantis I.</creatorcontrib><creatorcontrib>Endo, Yutaka</creatorcontrib><creatorcontrib>Ratti, Francesca</creatorcontrib><creatorcontrib>Marques, Hugo P.</creatorcontrib><creatorcontrib>Cauchy, François</creatorcontrib><creatorcontrib>Lam, Vincent</creatorcontrib><creatorcontrib>Poultsides, George A.</creatorcontrib><creatorcontrib>Popescu, Irinel</creatorcontrib><creatorcontrib>Alexandrescu, Sorin</creatorcontrib><creatorcontrib>Martel, Guillaume</creatorcontrib><creatorcontrib>Kitago, Minoru</creatorcontrib><creatorcontrib>Guglielmi, Alfredo</creatorcontrib><creatorcontrib>Hugh, Tom</creatorcontrib><creatorcontrib>Aldrighetti, Luca</creatorcontrib><creatorcontrib>Gleisner, Ana</creatorcontrib><creatorcontrib>Shen, Feng</creatorcontrib><creatorcontrib>Endo, Itaru</creatorcontrib><creatorcontrib>Pawlik, Timothy M.</creatorcontrib><title>Perioperative Lymphopenia is Associated with Increased Risk of Recurrence and Worse Survival Following Hepatectomy for Hepatocellular Carcinoma</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description><![CDATA[Introduction
Immune dysregulation may be associated with cancer progression. We sought to investigate the prognostic value of perioperative lymphopenia on short- and long-term outcomes among patients undergoing resection of hepatocellular carcinoma (HCC).
Methods
Patients undergoing resection of HCC between 2000 and 2020 were identified using an international database. The incidence and impact of perioperative lymphopenia [preoperative, postoperative day (POD) 1/3/5], defined as absolute lymphocyte count (ALC) <1000/μL, on short- and long-term outcomes was assessed.
Results
Among 1448 patients, median preoperative ALC was 1593/μL [interquartile range (IQR) 1208–2006]. The incidence of preoperative lymphopenia was 14.0%, and 50.2%, 45.1% and 35.6% on POD1, POD3 and POD5, respectively. Preoperative lymphopenia predicted 5-year overall survival (OS) [lymphopenia vs. no lymphopenia: 49.1% vs. 66.1%] and 5-year disease-free survival (DFS) [25.0% vs. 41.5%] (both
p
< 0.05). Lymphopenia on POD1 (5-year OS: 57.1% vs. 71.2%; 5-year DFS: 30.0% vs. 41.1%), POD3 (5-year OS: 57.3% vs. 68.9%; 5-year DFS: 35.4% vs. 42.7%), and POD5 (5-year OS: 53.1% vs. 66.1%; 5-year DFS: 32.8% vs. 42.3%) was associated with worse long-term outcomes (all
p
< 0.05). Patients with severe lymphopenia (ALC <500/μL) on POD5 had worse 5-year OS and DFS (5-year OS: 44.7% vs. 54.3% vs. 66.1%; 5-year DFS: 27.8% vs. 33.3% vs. 42.3%) [both
p
< 0.05], as well as higher incidence of overall (45.5% vs. 25.3% vs. 30.9%;
p
= 0.013) and major complications (18.2% vs. 3.4% vs. 4.5%;
p
< 0.001) versus individuals with moderate (ALC 500–1000/μL) or no lymphopenia following hepatectomy for HCC. After adjusting for competing risk factors, prolonged lymphopenia was independently associated with higher hazards of death [hazard ratio (HR) 1.38, 95% CI 1.11–1.72] and recurrence (HR 1.22, 95% CI 1.02–1.45).
Conclusion
Perioperative lymphopenia had short- and long-term prognostic implications among individuals undergoing hepatectomy for HCC.]]></description><subject>Cell number</subject><subject>Hepatectomy</subject><subject>Hepatobiliary Tumors</subject><subject>Hepatocellular carcinoma</subject><subject>Liver cancer</subject><subject>Lymphocytes</subject><subject>Lymphopenia</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Oncology</subject><subject>Risk factors</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kc1u1TAQhS0Eoj_wAiyQJTZsAv6Nk2V11dJKVwIVEMto4kxal8QOdnKr-xS8Mr5NAYkFK_uMP58ZzSHkFWfvuFD6feJMSVUwIQuuKs4L84Qcc51Lqqz403xnZVXUotRH5CSlO8a4kUw_J0ey4hUzzByTn58wujBhhNntkG7343SbpXdAXaJnKQXrYMaO3rv5ll55GxFSltcufaehp9dolxjRW6TgO_otxIT08xJ3bgcDvQjDEO6dv6GXOGUbO4dxT_sQVx0sDsMyQKQbiNb5MMIL8qyHIeHLx_OUfL04_7K5LLYfP1xtzraFlUbPRQettsag4QxZXwNreafyDmwPRpVKsrZUaJUoEdpWlAY5qFIzqLUFIXUlT8nb1XeK4ceCaW5Glw7jgMewpEbUosqbM8pk9M0_6F1Yos_TZUrKKrdVdabEStkYUorYN1N0I8R9w1lziKtZ42pyXM1DXM3B-vWj9dKO2P358jufDMgVSPnJ32D82_s_tr8A3qqigA</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Tsilimigras, Diamantis I.</creator><creator>Endo, Yutaka</creator><creator>Ratti, Francesca</creator><creator>Marques, Hugo P.</creator><creator>Cauchy, François</creator><creator>Lam, Vincent</creator><creator>Poultsides, George A.</creator><creator>Popescu, Irinel</creator><creator>Alexandrescu, Sorin</creator><creator>Martel, Guillaume</creator><creator>Kitago, Minoru</creator><creator>Guglielmi, Alfredo</creator><creator>Hugh, Tom</creator><creator>Aldrighetti, Luca</creator><creator>Gleisner, Ana</creator><creator>Shen, Feng</creator><creator>Endo, Itaru</creator><creator>Pawlik, Timothy M.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TO</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7994-9870</orcidid></search><sort><creationdate>20240401</creationdate><title>Perioperative Lymphopenia is Associated with Increased Risk of Recurrence and Worse Survival Following Hepatectomy for Hepatocellular Carcinoma</title><author>Tsilimigras, Diamantis I. ; Endo, Yutaka ; Ratti, Francesca ; Marques, Hugo P. ; Cauchy, François ; Lam, Vincent ; Poultsides, George A. ; Popescu, Irinel ; Alexandrescu, Sorin ; Martel, Guillaume ; Kitago, Minoru ; Guglielmi, Alfredo ; Hugh, Tom ; Aldrighetti, Luca ; Gleisner, Ana ; Shen, Feng ; Endo, Itaru ; Pawlik, Timothy M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-dab5c77e710e0f9a0b1d4481cfa746430b64ec426eabb267e1a4650a95ca23583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Cell number</topic><topic>Hepatectomy</topic><topic>Hepatobiliary Tumors</topic><topic>Hepatocellular carcinoma</topic><topic>Liver cancer</topic><topic>Lymphocytes</topic><topic>Lymphopenia</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Oncology</topic><topic>Risk factors</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tsilimigras, Diamantis I.</creatorcontrib><creatorcontrib>Endo, Yutaka</creatorcontrib><creatorcontrib>Ratti, Francesca</creatorcontrib><creatorcontrib>Marques, Hugo P.</creatorcontrib><creatorcontrib>Cauchy, François</creatorcontrib><creatorcontrib>Lam, Vincent</creatorcontrib><creatorcontrib>Poultsides, George A.</creatorcontrib><creatorcontrib>Popescu, Irinel</creatorcontrib><creatorcontrib>Alexandrescu, Sorin</creatorcontrib><creatorcontrib>Martel, Guillaume</creatorcontrib><creatorcontrib>Kitago, Minoru</creatorcontrib><creatorcontrib>Guglielmi, Alfredo</creatorcontrib><creatorcontrib>Hugh, Tom</creatorcontrib><creatorcontrib>Aldrighetti, Luca</creatorcontrib><creatorcontrib>Gleisner, Ana</creatorcontrib><creatorcontrib>Shen, Feng</creatorcontrib><creatorcontrib>Endo, Itaru</creatorcontrib><creatorcontrib>Pawlik, Timothy M.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tsilimigras, Diamantis I.</au><au>Endo, Yutaka</au><au>Ratti, Francesca</au><au>Marques, Hugo P.</au><au>Cauchy, François</au><au>Lam, Vincent</au><au>Poultsides, George A.</au><au>Popescu, Irinel</au><au>Alexandrescu, Sorin</au><au>Martel, Guillaume</au><au>Kitago, Minoru</au><au>Guglielmi, Alfredo</au><au>Hugh, Tom</au><au>Aldrighetti, Luca</au><au>Gleisner, Ana</au><au>Shen, Feng</au><au>Endo, Itaru</au><au>Pawlik, Timothy M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Perioperative Lymphopenia is Associated with Increased Risk of Recurrence and Worse Survival Following Hepatectomy for Hepatocellular Carcinoma</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2024-04-01</date><risdate>2024</risdate><volume>31</volume><issue>4</issue><spage>2568</spage><epage>2578</epage><pages>2568-2578</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract><![CDATA[Introduction
Immune dysregulation may be associated with cancer progression. We sought to investigate the prognostic value of perioperative lymphopenia on short- and long-term outcomes among patients undergoing resection of hepatocellular carcinoma (HCC).
Methods
Patients undergoing resection of HCC between 2000 and 2020 were identified using an international database. The incidence and impact of perioperative lymphopenia [preoperative, postoperative day (POD) 1/3/5], defined as absolute lymphocyte count (ALC) <1000/μL, on short- and long-term outcomes was assessed.
Results
Among 1448 patients, median preoperative ALC was 1593/μL [interquartile range (IQR) 1208–2006]. The incidence of preoperative lymphopenia was 14.0%, and 50.2%, 45.1% and 35.6% on POD1, POD3 and POD5, respectively. Preoperative lymphopenia predicted 5-year overall survival (OS) [lymphopenia vs. no lymphopenia: 49.1% vs. 66.1%] and 5-year disease-free survival (DFS) [25.0% vs. 41.5%] (both
p
< 0.05). Lymphopenia on POD1 (5-year OS: 57.1% vs. 71.2%; 5-year DFS: 30.0% vs. 41.1%), POD3 (5-year OS: 57.3% vs. 68.9%; 5-year DFS: 35.4% vs. 42.7%), and POD5 (5-year OS: 53.1% vs. 66.1%; 5-year DFS: 32.8% vs. 42.3%) was associated with worse long-term outcomes (all
p
< 0.05). Patients with severe lymphopenia (ALC <500/μL) on POD5 had worse 5-year OS and DFS (5-year OS: 44.7% vs. 54.3% vs. 66.1%; 5-year DFS: 27.8% vs. 33.3% vs. 42.3%) [both
p
< 0.05], as well as higher incidence of overall (45.5% vs. 25.3% vs. 30.9%;
p
= 0.013) and major complications (18.2% vs. 3.4% vs. 4.5%;
p
< 0.001) versus individuals with moderate (ALC 500–1000/μL) or no lymphopenia following hepatectomy for HCC. After adjusting for competing risk factors, prolonged lymphopenia was independently associated with higher hazards of death [hazard ratio (HR) 1.38, 95% CI 1.11–1.72] and recurrence (HR 1.22, 95% CI 1.02–1.45).
Conclusion
Perioperative lymphopenia had short- and long-term prognostic implications among individuals undergoing hepatectomy for HCC.]]></abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>38180707</pmid><doi>10.1245/s10434-023-14811-7</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-7994-9870</orcidid></addata></record> |
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| ispartof | Annals of surgical oncology, 2024-04, Vol.31 (4), p.2568-2578 |
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| subjects | Cell number Hepatectomy Hepatobiliary Tumors Hepatocellular carcinoma Liver cancer Lymphocytes Lymphopenia Medicine Medicine & Public Health Oncology Risk factors Surgery Surgical Oncology |
| title | Perioperative Lymphopenia is Associated with Increased Risk of Recurrence and Worse Survival Following Hepatectomy for Hepatocellular Carcinoma |
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