Ren Zhiyao, Yang Jing, Liang Jiahui, Xu Yunfeng, Lu Guanda, Han Yanxun, Zhu Jie, Tan Husheng, Xu Tao, Ren Min
Department of Breast Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Front Surg. 2023 Jan 6;9:927491. doi: 10.3389/fsurg.2022.927491. eCollection 2022.
This stydy aims to assess the value of monitoring of postoperative neutrophil-to-lymphocyte ratio (NLR), D-dimer, and carbohydrate antigen 153 (CA153) for diagnosis of breast cancer (BC) recurrence and metastasis.
MATERIALS/METHODS: A cohort of 252 BC patients who underwent surgery at the First Affiliated Hospital of Anhui Medical University between August 2008 and August 2018 were enrolled in this retrospective study. All patients were examined during outpatient follow-ups every 3 months for 5 years postoperation and every 6 months thereafter. Recurrence or metastasis was recorded for 131 patients but not for the remaining 121. Retrospective analysis of hematological parameters and clinicopathological characteristics allowed comparison between the two groups and evaluation of these parameters for the recurrent and metastatic patients.
Lymph node metastasis, higher tumor node metastasis (TNM) staging, and higher histological grade correlated with BC recurrence and metastasis ( < 0.05). Statistical differences were found in absolute neutrophil count (ANC), absolute lymphocyte count (ALC), CEA, CA153, D-dimer, NLR, platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) between the recurrent and metastatic and control groups ( < 0.05). Logistic regression analysis showed that CA153, D-dimer, NLR, and TNM staging were risk factors for BC recurrence and metastasis ( < 0.05). Combined values for the NLR, D-dimer, and CA153 had good diagnostic values, giving the highest area under the curve (AUC) of 0.913. High NLR, D-dimer, and CA153 values were significantly associated with recurrence and metastasis at multiple sites, lymph node metastasis, and higher TNM staging ( < 0.05). Patients with high CA153 were more likely to have bone metastases ( < 0.05), and those with high D-dimer were prone to lung metastasis ( < 0.05). With the increasing length of the postoperative period, the possibility of liver metastases gradually decreased, while that of chest wall recurrence gradually increased ( < 0.05).
Monitoring postoperative NLR, D-dimer, and CA153 is a convenient, practical method for diagnosing BC recurrence and metastasis. These metrics have good predictive value in terms of sites of recurrence and metastasis and the likelihood of multiple metastases.
本研究旨在评估监测术后中性粒细胞与淋巴细胞比值（NLR）、D-二聚体和糖类抗原153（CA153）对乳腺癌（BC）复发和转移的诊断价值。
材料/方法：本回顾性研究纳入了2008年8月至2018年8月在安徽医科大学第一附属医院接受手术的252例BC患者。所有患者术后5年内每3个月进行一次门诊随访检查，此后每6个月检查一次。记录了131例患者的复发或转移情况，其余121例未记录。通过对血液学参数和临床病理特征进行回顾性分析，比较两组情况，并评估复发和转移患者的这些参数。
淋巴结转移、更高的肿瘤淋巴结转移（TNM）分期和更高的组织学分级与BC复发和转移相关（<0.05）。复发和转移组与对照组之间在绝对中性粒细胞计数（ANC）、绝对淋巴细胞计数（ALC）、癌胚抗原（CEA）、CA153、D-二聚体、NLR、血小板与淋巴细胞比值（PLR）和单核细胞与淋巴细胞比值（MLR）方面存在统计学差异（<0.05）。逻辑回归分析表明，CA153、D-二聚体、NLR和TNM分期是BC复发和转移的危险因素（<0.05）。NLR、D-二聚体和CA153的联合值具有良好的诊断价值，曲线下面积（AUC）最高为0.913。高NLR、D-二聚体和CA153值与多处复发和转移、淋巴结转移及更高的TNM分期显著相关（<0.05）。CA153高的患者更易发生骨转移（<0.05），D-二聚体高的患者易发生肺转移（<0.05）。随着术后时间延长，肝转移可能性逐渐降低，而胸壁复发可能性逐渐增加（<0.05）。
监测术后NLR、D-二聚体和CA153是诊断BC复发和转移的一种便捷、实用的方法。这些指标在复发和转移部位以及多发转移可能性方面具有良好的预测价值。
