{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:18:37Z","timestamp":1788153517861,"version":"build-2803163510"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate the prognostic value of treatment related decline of peripheral absolute lymphocyte count (ALC) in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) after preoperative radiation therapy (RT) with or without chemotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This\n                      <jats:italic>post-hoc<\/jats:italic>\n                      analysis was performed using data of 222 patients from a phase III, randomized controlled trial in LA-HNSCC. ALCs were measured before, during, and after RT. The ALC decline was defined as the difference between pre-treatment ALC and the nadir ALC observed during RT. Optimal cut-off values for hematologic and nutritional indices were determined by ROC analysis. Survival outcomes were estimated using Kaplan-Meier analysis and compared with the log-rank test. Prognostic factors were identified using LASSO regression and multivariable Cox models. A nomogram was constructed based on independent prognostic variables.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      With a median follow-up of 132.0 (IQR: 104.17-151.73) months, no significant difference was observed in the 10-year overall survival (OS) and progression-free survival (PFS) between treatment groups. Lymphopenia during RT occurred in 197 patients (88.7%), including grade 3 in 112 (50.5%) and grade 4 in 10 (4.5%). An ALC decline &amp;gt; 0.74\u00d710\n                      <jats:sup>9<\/jats:sup>\n                      \/L was independently associated with poorer OS and PFS. The nomogram integrating T stage, N stage, ALC decline, and neutrophil-to-albumin ratio (NAR) yielded a C-index of 0.66, a 5-year AUC of 0.738, good calibration, and favorable net benefit on DCA.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Treatment-related ALC decline is an independent adverse prognostic factor in LA-HNSCC. A nomogram incorporating ALC decline performs favorably in individualized survival prediction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1805437","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T04:28:55Z","timestamp":1788150535000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment-related lymphopenia predicts long-term survival in locally advanced head and neck cancer: Post-Hoc analysis of a randomized phase III trial"],"prefix":"10.3389","volume":"17","author":[{"given":"Gulidanna","family":"Shayan","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, 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