术前诊断为导管原位癌病例中预测浸润性导管癌的因素。
Factors predictive of invasive ductal carcinoma in cases preoperatively diagnosed as ductal carcinoma in situ.
机构信息
Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
Department of Pharmacology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
出版信息
BMC Cancer. 2020 Jun 3;20(1):513. doi: 10.1186/s12885-020-07001-1.
BACKGROUND
Invasion is often found during postoperative pathological examination of cases diagnosed as ductal carcinoma in situ (DCIS) by histological examinations such as core needle biopsy (CNB) or vacuum-assisted biopsy (VAB). A meta-analysis reported that 25.9% of invasive ductal carcinoma (IDC) cases are preoperatively diagnosed by CNB as DCIS. Risk factors for invasion have been studied by postoperative examination, but no factors have been found that could be obtained preoperatively from blood tests. In this study, we investigated factors predictive of invasion based on preoperative blood tests in patients diagnosed with DCIS by preoperative biopsy.
METHODS
In this study, 118 patients who were diagnosed with DCIS by preoperative biopsy were included. Biopsies were performed with 16-gauge CNB or VAB. Peripheral blood was obtained at the time of diagnosis. This study evaluated absolute platelet count, absolute lymphocyte count, lactate dehydrogenase, carcinoembryonic antigen, and cancer antigen 15-3 (CA15-3). The platelet-lymphocyte ratio (PLR) was calculated by dividing the absolute platelet count by the absolute lymphocyte count, and patients were grouped into high PLR (≥160.0) and low PLR (< 160.0) groups.
RESULTS
Invasion was found more frequently after surgery in pathologically high-grade cases than in pathologically not-high-grade cases (p = 0.015). The median PLR was 138.9 and 48 patients (40.7%) were classified into the high PLR group. The high PLR group was significantly more likely to have invasion detected by the postoperative pathology than the low PLR group (p = 0.018). In multivariate analysis of factors predictive of invasion in postoperative pathology, a high PLR (p = 0.006, odds ratio [OR] = 3.526) and biopsy method (VAB vs. CNB, p = 0.001, OR = 0.201) was an independent risk factor.
CONCLUSIONS
The PLR may be a predictor of invasion in the postoperative pathology for patients diagnosed with DCIS by preoperative biopsy.
背景
通过核心针活检（CNB）或真空辅助活检（VAB）等组织学检查诊断为导管原位癌（DCIS）的病例，术后病理检查常发现浸润。一项荟萃分析报告称，25.9%的浸润性导管癌（IDC）病例术前通过 CNB 诊断为 DCIS。已经对浸润的危险因素进行了术后检查，但未发现可通过术前血液检查获得的因素。在这项研究中，我们研究了术前活检诊断为 DCIS 的患者基于术前血液检查的预测浸润的因素。
方法
本研究纳入了 118 例术前活检诊断为 DCIS 的患者。活检采用 16 号 CNB 或 VAB 进行。诊断时采集外周血。本研究评估了绝对血小板计数、绝对淋巴细胞计数、乳酸脱氢酶、癌胚抗原和癌抗原 15-3（CA15-3）。血小板-淋巴细胞比值（PLR）通过将绝对血小板计数除以绝对淋巴细胞计数计算得出，将患者分为高 PLR（≥160.0）和低 PLR（<160.0）组。
结果
与病理非高级别病例相比，病理高级别病例术后更常发现浸润（p=0.015）。中位 PLR 为 138.9，48 例（40.7%）患者被归入高 PLR 组。高 PLR 组术后病理浸润的检出率明显高于低 PLR 组（p=0.018）。术后病理浸润的多因素分析中，高 PLR（p=0.006，优势比[OR] = 3.526）和活检方法（VAB 与 CNB，p=0.001，OR = 0.201）是独立的危险因素。
结论
PLR 可能是术前活检诊断为 DCIS 的患者术后病理浸润的预测因子。
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