Suppan Christoph, Bjelic-Radisic Vesna, La Garde Marlen, Groselj-Strele Andrea, Eberhard Katharina, Samonigg Hellmut, Loibner Hans, Dandachi Nadia, Balic Marija
Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
Department of Gynaecology and Obstetrics, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria.
BMC Cancer. 2015 Dec 29;15:1027. doi: 10.1186/s12885-015-2005-3.
The primary goal of preoperative systemic treatment (PST) in patients with breast cancer is downsizing of tumors to enhance the rate of breast conserving surgery. Additionally, preoperative systemic treatment offers the possibility to assess for chemosensitivity of early stage disease. In various cancers the prognostic value of neutrophil/lymphocyte ratio (NLR) was demonstrated, indicating that high NLR determines worse prognosis of the patients. The goal of our study was to evaluate the predictive and prognostic value of NLR in early stage breast cancer patients undergoing PST.
247 female patients with histologically proven breast cancer were analysed in this retrospective analysis. The NLR before the initiation of PST was documented. Histopathological response in surgically removed specimens was evaluated using a modified Sinn regression score and the pCR defined as no invasive tumor in primary tumor and lymph nodes. NLR was correlated with response to PST and disease free survival.
PST was categorized into five groups (anthracycline containing, anthracycline and taxane containing, taxane containing, hormone treatment and other chemotherapies). pCR rate was defined as no invasive rest of tumor either in primary tumor or (ypT0 = Sinn) or in primary tumor and in lymph nodes (ypT0isypN0). Median NLR in patients without any invasive tumor rest was significantly higher than in patients either with some invasive tumor rest or not responding to chemotherapy. Despite this primary difference, the results were not stable across the analysed treatment groups particularly in the group with highest pCR rates (taxane and anthracycline treatment). Further, no association with disease free survival could be observed.
Although there was a reverse trend with the higher NLR prior to systemic treatment in patients who achieved pCR, we could not demonstrate predictive or prognostic value of NLR in the cohort of early stage breast cancer patients treated with PST.
乳腺癌患者术前全身治疗（PST）的主要目标是缩小肿瘤大小，以提高保乳手术的成功率。此外，术前全身治疗还能够评估早期疾病的化疗敏感性。在多种癌症中，中性粒细胞/淋巴细胞比值（NLR）的预后价值已得到证实，这表明高NLR预示着患者预后较差。我们研究的目的是评估NLR在接受PST的早期乳腺癌患者中的预测和预后价值。
本回顾性分析纳入了247例经组织学证实的女性乳腺癌患者。记录PST开始前的NLR。使用改良的辛恩回归评分评估手术切除标本的组织病理学反应，并将pCR定义为原发肿瘤和淋巴结中无浸润性肿瘤。将NLR与PST反应和无病生存期进行关联分析。
PST分为五组（含蒽环类、含蒽环类和紫杉烷类、含紫杉烷类、激素治疗和其他化疗）。pCR率定义为原发肿瘤或（ypT0 = 辛恩）或原发肿瘤和淋巴结中无肿瘤浸润残留（ypT0isypN0）。无任何肿瘤浸润残留患者的NLR中位数显著高于有肿瘤浸润残留或对化疗无反应的患者。尽管存在这一主要差异，但在分析的各个治疗组中结果并不稳定，尤其是在pCR率最高的组（紫杉烷和蒽环类治疗组）。此外，未观察到与无病生存期的关联。
尽管在达到pCR的患者中，全身治疗前NLR较高呈现出相反的趋势，但我们未能在接受PST的早期乳腺癌患者队列中证明NLR的预测或预后价值。
