Peer-reviewedCC BY 4.0Frontiers in Oncology23 Oct 2026

Association between absolute lymphocyte count and outcomes of radiotherapy combined with immunotherapy in elderly patients with inoperable esophageal squamous cell carcinoma

Youqin Jiang^1,2
Weiwei Chen²
Daguang Ni²
Xu Liang²

¹Department of Radiotherapy, Yancheng Third People’s Hospital, The affiliated hospital of Jiangsu Medical College
²Department of Radiotherapy, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People’s Hospital

Abstract

Objective: To determine whether pretreatment absolute lymphocyte count (ALC) is related to clinical outcomes among elderly patients with inoperable ESCC receiving definitive radiotherapy combined with immunotherapy.

Methods: Elderly patients (≥ 60 years) with incurable ESCC who underwent programmed death-1 (PD-1) inhibitor therapy and definitive radiotherapy were retrospectively enrolled. ROC analysis identified the most discriminative ALC cutoff. Short-term efficacy was compared between groups, and Cox regression assessed factors related to overall survival (OS) and progression-free survival (PFS).

Results: Data from 102 elderly patients were evaluated. The objective response rate (ORR) was 70.59%; median PFS and OS were 21 and 28 months, respectively. ROC analysis identified 1.24 × 10 ⁹ /L as the cutoff value for ALC. The response rate was markedly higher among patients with high ALC than among those with low ALC (86.0% vs. 51.1%, P < 0.001). ALC was identified as an independent factor associated with short-term treatment response by multivariate logistic regression (OR = 4.716, 95% CI: 1.167–19.062, P = 0.030). Longer median OS and PFS were observed in high-ALC patients. In the multivariate Cox analysis, higher ALC remained independently related to improved PFS (HR = 0.450, 95% CI 0.213–0.951, P = 0.036) and improved OS (HR = 0.425, 95% CI 0.184–0.982, P = 0.045).

Conclusion: Baseline ALC has the potential to be used to guide patient selection and individualized treatment planning, because this readily available biomarker was independently associated with treatment response and survival.

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BibTeX RIS

BibTeX

@article{jiang2026association,
  title = {{Association between absolute lymphocyte count and outcomes of radiotherapy combined with immunotherapy in elderly patients with inoperable esophageal squamous cell carcinoma}},
  author = {Youqin Jiang and Weiwei Chen and Daguang Ni and Xu Liang},
  journal = {Frontiers in Oncology},
  year = {2026},
  month = oct,
  doi = {10.3389/fonc.2026.1953153},
  url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1953153/full},
  note = {CC BY 4.0},
}

RIS

TY  - JOUR
TI  - Association between absolute lymphocyte count and outcomes of radiotherapy combined with immunotherapy in elderly patients with inoperable esophageal squamous cell carcinoma
AU  - Youqin Jiang
AU  - Weiwei Chen
AU  - Daguang Ni
AU  - Xu Liang
PY  - 2026
DA  - 2026/10/23
JO  - Frontiers in Oncology
DO  - 10.3389/fonc.2026.1953153
UR  - https://www.frontiersin.org/articles/10.3389/fonc.2026.1953153/full
AB  - Objective: To determine whether pretreatment absolute lymphocyte count (ALC) is related to clinical outcomes among elderly patients with inoperable ESCC receiving definitive radiotherapy combined with immunotherapy.  Methods: Elderly patients (≥ 60 years) with incurable ESCC who underwent programmed death-1 (PD-1) inhibitor therapy and definitive radiotherapy were retrospectively enrolled. ROC analysis identified the most discriminative ALC cutoff. Short-term efficacy was compared between groups, and Cox regression assessed factors related to overall survival (OS) and progression-free survival (PFS).  Results: Data from 102 elderly patients were evaluated. The objective response rate (ORR) was 70.59%; median PFS and OS were 21 and 28 months, respectively. ROC analysis identified 1.24 × 10 ⁹ /L as the cutoff value for ALC. The response rate was markedly higher among patients with high ALC than among those with low ALC (86.0% vs. 51.1%, P &lt; 0.001). ALC was identified as an independent factor associated with short-term treatment response by multivariate logistic regression (OR = 4.716, 95% CI: 1.167–19.062, P = 0.030). Longer median OS and PFS were observed in high-ALC patients. In the multivariate Cox analysis, higher ALC remained independently related to improved PFS (HR = 0.450, 95% CI 0.213–0.951, P = 0.036) and improved OS (HR = 0.425, 95% CI 0.184–0.982, P = 0.045).  Conclusion: Baseline ALC has the potential to be used to guide patient selection and individualized treatment planning, because this readily available biomarker was independently associated with treatment response and survival.
SN  - 2234-943X
ER  -

Abstract

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