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Comparative Study
. 2018 Mar 1;18(1):235.
doi: 10.1186/s12885-018-4136-9.

Effect of surgery and radiotherapy on complete blood count, lymphocyte subsets and inflammatory response in patients with advanced oral cancer

Tadej Dovšak  1   2 , Alojz Ihan  3 , Vojko Didanovič  4   5 , Andrej Kansky  4   5 , Miha Verdenik  4   5 , Nataša Ihan Hren  4   5
Affiliations
Comparative Study

Effect of surgery and radiotherapy on complete blood count, lymphocyte subsets and inflammatory response in patients with advanced oral cancer

Tadej Dovšak et al. BMC Cancer. .

Abstract

Background: The immune system has a known role in the aetiology, progression and final treatment outcome of oral squamous cell cancers. The aim of this study was to evaluate the influence of radical surgery and radiotherapy on advanced oral squamous cell carcinoma blood counts, lymphocyte subsets and levels of acute inflammatory response markers.

Methods: Blood samples were obtained from 56 patients 5 days before and 10 days after surgery, 30 days and 1 year after radiotherapy. The whole blood count, lymphocyte subsets and inflammatory response markers (C-reactive protein, erythrocyte sedimentation rate, leukocyte count, expression of index CD64 and index CD163 on neutrophils and monocytes) were measured, statistically analysed and correlated with clinical treatment outcomes.

Results: The post-operative period was characterised by the onset of anaemia, thrombocytosis, lymphopenia with reduced B lymphocyte, T helper cell and NK cell counts, and a rise in acute phase reactants. Immediately after radiotherapy, the anaemia improved, the lymphopenia worsened, and thrombocyte levels returned to pre-treatment values. There was a drop in counts across the T and B cell lines, including a reduction in B lymphocytes, naïve and memory T cells with reduced CD4+ and CD8+ counts and a decreased CD4/CD8 ratio. One year after radiotherapy all the lymphocyte subsets remained depressed, the only exception being NK cells, whose levels returned to pre-treatment values.

Conclusions: We concluded that surgery resulted in a stronger acute phase response than radiotherapy, while radiotherapy caused a long-lasting reduction in lymphocyte counts. There was no correlation between any of the pre-treatment parameters and the clinical outcome.

Keywords: Lymphopenia; Oral cancer; Radiotherapy; Surgery; Treatment outcome.

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Conflict of interest statement

Ethics approval and consent to participate

This study was reviewed and approved by the Slovenian National Medical Ethics Committee, Approval No. 69/06/07. Written informed consent was obtained from all participants.

Consent for publication

Not applicable

Competing interests

None declared

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Diagram of impact of surgery and radiotherapy on lymphocyte populations (CD3+, CD19+, NK cells, CD4+, CD8+, CD45RA+, CD45RO+) indexed on T1 values
Fig. 2
Fig. 2
Values of HLA/DR3, ESR, Neutrophyls, Albumin and CRP indexed to T1 levels
See this image and copyright information in PMC

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