The Relationship Between Absolute Lymphocyte Count And Plasma D-dimer With The Short-term Efficacy And Prognosis Of The Anlotinib-administered Patients With Advanced Malignant Tumors

Objective: We aim to study the changes of the levels of absolute lymphocyte count and D-dimer in patients with advanced malignant tumors treated with anlotinib,so as to explore the significance of anlotinib in determining short-term efficacy and predicting prognosis.Methods: In this retrospective analysis,54 patients with advanced malignant tumors who received at least 1 month of treatment with anlotinib were enrolled.We collected the patient’s general information and recorded patients’ absolute lymphocyte count and Ddimer testing results at the time-points of baseline,best response(complete remission,partial remission or stable disease),and progressive disease.In addition,we figured out progression-free survival(PFS)through pathography access and telephone follow-up,analysing the relationship between the level of absolute lymphocyte count and of D-dimer and the short-term efficacy.Finally,the differences in the median PFS of patients with different absolute lymphocyte counts and D dimer levels before treatment were compared,then multivariate COX regression analysis was performed to find out the independent risk factors affecting prognosis.Results: Anlotinib exhibited obvious inhibitory effect on several tumors,showing a broad spectrum of anti-tumor effect,with good safety.The log-rank test was used for univariate analysis of several clinical indicators,and the results showed that the median PFS of patients smoking,not having been received tyrosine kinase inhibitors(TKI),with ECOG score 0/1 or with hand-foot syndrome was significantly longer than those not smoking,having been received TKI,with ECOG score 2 or without hand-foot syndrome.Further analysis of the relationship between absolute lymphocyte count / D-dimer and the shortterm efficacy / PFS revealed a certain change patterns: when the response(partial remission or stable disease)occurred,the absolute lymphocyte count increased and the D-dimer level decreased,but,when progression occurred,the absolute lymphocyte count decreased and the D-dimer level increased.Single factor analysis using log-rank test showed that patients with pre-treatment absolute lymphocyte count > 0.7*10^9/L had longer PFS than patients with absolute lymphocyte count ≤0.7*10^9/L,and,comparing with patients with D-dimer ≤239(μg/L),patients with pre-treatment D-dimer > 239(μg/L)had longer PFS.COX regression analysis showed that lower pre-treatment absolute lymphocyte count was an independent risk factor(HR=2.727;95%CI: 1.242-5.988,P=0.012).Conclusion: Our study suggests that changes in absolute lymphocyte count and D-dimer levels may be used to monitor and predict clinical outcomes in anlotinib-administered patients with advanced refractory malignant tumors,and the pre-treatment absolute lymphocyte count could be an independent risk factor for prognosis.