Department of Family Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea.
Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
J Altern Complement Med. 2020 Nov;26(11):1039-1046. doi: 10.1089/acm.2020.0138. Epub 2020 Sep 1.
Breast cancer is very common, and the incidence is growing every year. Most breast cancers are treated with radiation after surgery. As a side effect of radiation therapy, inflammation, as well as the neutrophil-lymphocyte ratio (NLR), level increases. However, high NLR levels act as independent prognostic factors for increased mortality in all cancers. In this study, the authors investigated whether administration of vitamin C, which is effective in suppressing inflammation, may help to reduce high levels of NLR produced by radiation therapy. This study was performed retrospectively among 424 patients who were diagnosed with breast cancer and were treated with postoperative radiotherapy at Kosin University Gospel Hospital from January 2011 to December 2017. Among them, 354 patients received radiation therapy without vitamin C (the control group), and 70 experimental patients received vitamin C intravenously twice a week for at least 4 weeks during radiation therapy. The experimental group was divided into two groups according to the dose administrated: a low-dose vitamin C group (less than 1 g/kg, 52 patients) and a high-dose vitamin C group (more than 1 g/kg, 18 patients). The authors conducted three NLR measurements: before and after radiation therapy and at 3 months after radiation therapy; the authors then compared the change in NLR over time between the groups using repeated measures analysis of variance. In the control group and the low-dose vitamin C-administered group, NLR was increased at the endpoint compared to before the radiotherapy, whereas NLR values in the high-dose vitamin C group were 8.4 ± 1.7, 5.9 ± 1.3, and 4.3 ± 1.5, showing a continuous decrease and a statistically significant difference ( = 0.033). These results were similarly observed in models adjusted by the patient's age and American Joint Committee on Cancer stage, with borderline significance ( = 0.065). Elevated NLR, a measure of systemic inflammation, has been associated with higher mortality cancer patients, including breast cancer patients. In this observational study, NLR was significantly decreased during radiation therapy in patients administered high-dose vitamin C.
乳腺癌很常见，发病率每年都在增加。大多数乳腺癌在手术后都需要进行放射治疗。作为放射治疗的副作用，炎症以及中性粒细胞-淋巴细胞比值（NLR）水平会升高。然而，高 NLR 水平是所有癌症中死亡率增加的独立预后因素。在这项研究中，作者研究了维生素 C 是否可以抑制炎症，从而有助于降低放射治疗引起的高 NLR 水平。
这项研究是在 2011 年 1 月至 2017 年 12 月期间在韩国果川大学福音医院接受术后放射治疗的 424 例乳腺癌患者中进行的回顾性研究。其中 354 例患者未接受维生素 C 治疗（对照组），70 例患者在放射治疗期间每周静脉注射维生素 C 两次，至少 4 周。实验组根据剂量分为两组：低剂量维生素 C 组（<1g/kg，52 例）和高剂量维生素 C 组（>1g/kg，18 例）。作者进行了三次 NLR 测量：放射治疗前后和放射治疗后 3 个月；然后使用重复测量方差分析比较两组之间 NLR 随时间的变化。
在对照组和低剂量维生素 C 组中，与放射治疗前相比，终点时 NLR 增加，而高剂量维生素 C 组的 NLR 值分别为 8.4±1.7、5.9±1.3 和 4.3±1.5，呈持续下降趋势，且具有统计学意义（ = 0.033）。在调整患者年龄和美国癌症联合委员会分期的模型中也观察到了类似的结果，具有边界显著性（ = 0.065）。
升高的 NLR，即全身炎症的一种衡量标准，与包括乳腺癌患者在内的癌症患者的高死亡率相关。在这项观察性研究中，高剂量维生素 C 治疗的患者在放射治疗过程中 NLR 明显降低。
