Severe radiation-induced lymphopenia and its impact on overall survival in solid tumors: A scoping review of systematic reviews

作者：Zhang S, Dube S, Kakumanu S, Pareek V · 发表于：Journal of cancer research and therapeutics · 年份：2026 · DOI：10.4103/jcrt.jcrt_1997_25 · 研究领域：Meta-analysis、overall survival、prognosis、radiation-induced lymphopenia、solid tumors、systematic review

Radiation therapy is a cornerstone of treatment for solid tumors, yet it often induces lymphopenia, a condition linked to poorer clinical outcomes. This scoping review synthesizes evidence from systematic reviews to evaluate the prognostic impact of severe radiation-induced lymphopenia (RIL) on overall survival (OS) in patients with solid tumors. A systematic literature search was conducted across PubMed, Cochrane Central, and EMBASE using the following keywords: "radiation," "lymphopenia," "solid tumors," "survival AND mortality," and "systematic review AND meta-analysis," up to November 30, 2023. Reviews reporting the prognostic relationship between RIL and survival were included, and pooled adjusted hazard ratios (aHRs) were calculated using a random-effects model. Subgroup analyses examined the impact of grade 3 or higher RIL across different tumor types. Of 21 identified reviews, 10 were included, covering 93 studies and 11,565 patients. The adjusted incidence rate of severe lymphopenia averaged 26.7% (range: 18.6-88.0%). The pooled aHR for OS was 1.72 (95% CI: 1.33-1.87) for grade ≥3 RIL versus grade 0-2 RIL, and 1.59 (95% CI: 1.31-1.92) for grade 4 RIL versus grade 0-3 RIL. Significant prognostic effects were observed in esophageal, head and neck, pancreatic, cervical, central nervous system, and lung cancers. Genitourinary tumors showed associations with medium-high radiation doses to pelvic and iliac bone marrow. Severe RIL consistently predicts poorer OS, emphasizin...