The B. Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Department of Cardiology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Clin Cardiol. 2023 Mar;46(3):328-335. doi: 10.1002/clc.23966. Epub 2023 Jan 20.
Cardiotoxicity, defined mainly as left ventricle (LV) dysfunction, is a significant side effect of anthracyclines (ANT) therapy. The need for an early simple marker to identify patients at risk is crucial. A high neutrophil-to-lymphocyte ratio (NLR) has been associated with poor prognosis in cancer patients; however, its role as a predictor for cardiotoxicity development is unknown.
Evaluating whether elevated NLR, during ANT exposure, plays a predictive role in the development of cardiotoxicity as defined by LV global longitudinal strain (LV GLS) relative reduction (≥10%).
Data were prospectively collected as part of the Israel Cardio-Oncology Registry. A total of 74 female patients with breast cancer, scheduled for ANT therapy were included. NLR levels were assessed at baseline (T1) and during ANT therapy (T2). All patients underwent serial echocardiography at baseline (T1) and after the completion of ANT therapy (T3). NLR ≥ 2.58 at T2 was found to be the optimal predictive cutoff for LV GLS deterioration. A relative LV GLS reduction ≥10% was significantly more common among patients with high NLR (50% vs. 20%, p = .009). NLR ≥ 2.58 at T2 increases the risk for LV GLS reduction by fourfold (odds ratio [OR]: 4.63, 95% confidence interval [CI]: 1.29-16.5, p = .02), with each increase of 1-point NLR adding an additional 15% risk (OR: 1.15, 95% CI: 1.01-1.32, p = .046).
Our study provides novel data that high NLR levels, during ANT exposure, have an independent association with the development of LV dysfunction. Routine surveillance of NLR may be an effective means of risk-stratifying.
心脏毒性主要表现为左心室（LV）功能障碍，是蒽环类药物（ANT）治疗的一个重要副作用。因此，需要一种早期的简单标志物来识别有风险的患者，这一点至关重要。高中性粒细胞与淋巴细胞比值（NLR）与癌症患者的不良预后相关；然而，其作为预测心脏毒性发展的作用尚不清楚。
评估在 ANT 暴露期间升高的 NLR 是否在 LV 整体纵向应变（LV GLS）相对降低（≥10%）定义的心脏毒性发展中起预测作用。
数据作为以色列心脏肿瘤学注册处的一部分进行前瞻性收集。共纳入 74 名计划接受 ANT 治疗的乳腺癌女性患者。在基线（T1）和 ANT 治疗期间（T2）评估 NLR 水平。所有患者在基线（T1）和 ANT 治疗完成后（T3）均接受了系列超声心动图检查。T2 时 NLR≥2.58 被发现是预测 LV GLS 恶化的最佳临界值。T2 时 NLR≥2.58 的患者中，LV GLS 相对降低≥10%的比例显著更高（50%比 20%，p=0.009）。T2 时 NLR≥2.58 使 LV GLS 降低的风险增加了四倍（比值比 [OR]：4.63，95%置信区间 [CI]：1.29-16.5，p=0.02），NLR 每增加 1 分，风险增加 15%（OR：1.15，95%CI：1.01-1.32，p=0.046）。
我们的研究提供了新的数据，表明 ANT 暴露期间的高 NLR 水平与 LV 功能障碍的发生有独立关联。常规监测 NLR 可能是一种有效的风险分层方法。
