Impact of baseline lymphopenia on outcomes of definitive treatment for locally advanced cervical cancer

The purpose of this study is to evaluate the association between lymphopenia and survival in women with locally advanced cervical cancer (LACC) treated with definitive chemoradiation (CRT). We retrospectively reviewed patients with LACC treated at a single institution from 2004 to 2021. Patient and treatment characteristics were recorded along with baseline absolute lymphocyte counts (ALC). Overall survival (OS), progression free survival (PFS), and local control (LC) were calculated from start of treatment to date of last follow-up. Cox regression and competing risks regression model were performed to evaluate whether baseline ALC was associated with OS, PFS, or LC. 246 patients met study inclusion criteria with stage IB – IV disease with a median follow up of 2.8 years (range 0.2–13.4 years). 5-year OS, PFS, and LC were 68.4 % (95 % CI 61.7–75.9), 57.2 % (95 % CI 50.4–64.8), and 79.0 % (95 % CI 73.0–84.4), respectively. Baseline lymphopenia (ALC < 1000 cells/mm3) was present in 12.5 % of patients. OS was improved in the patients without lymphopenia, with a 5-year OS of 69.0 % (95 % CI 61.6–77.3) versus 63.0 % (95 % CI 47.6–83.3)in the lymphopenia group (p = 0.233), though this did not meet statistical significance. PFS also trended towards improvement in patients without baseline lymphopenia, with a 5-year PFS of 58.5 % (95 % CI 51.2–66.8) versus 48.5 % (95 % CI 32.8–71.7), p = 0.220. No significant difference was found for LC in the patients without lymphopenia, p = 0.745. In this single institution experience of LACC treated with definitive CRT, we found that baseline lymphopenia trends toward inferior OS and PFS.