Department of Surgery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland.
Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland.
Br J Surg. 2024 May 3;111(5). doi: 10.1093/bjs/znae132.
Systemic inflammatory response markers have been found to have a prognostic role in several cancers, but their value in predicting the response to neoadjuvant chemotherapy in breast cancer is uncertain. A systematic review and meta-analysis of the literature was carried out to investigate this.
A systematic search of electronic databases was conducted to identify studies that explored the predictive value of circulating systemic inflammatory response markers in patients with breast cancer before commencing neoadjuvant therapy. A meta-analysis was undertaken for each inflammatory marker where three or more studies reported pCR rates in relation to the inflammatory marker. Outcome data are reported as ORs and 95% confidence intervals.
A total of 49 studies were included, of which 42 were suitable for meta-analysis. A lower pretreatment neutrophil-to-lymphocyte ratio was associated with an increased pCR rate (pooled OR 1.66 (95% c.i. 1.32 to 2.09); P < 0.001). A lower white cell count (OR 1.96 (95% c.i. 1.29 to 2.97); P = 0.002) and a lower monocyte count (OR 3.20 (95% c.i. 1.71 to 5.97); P < 0.001) were also associated with a pCR. A higher lymphocyte count was associated with an increased pCR rate (OR 0.44 (95% c.i. 0.30 to 0.64); P < 0.001).
The present study found the pretreatment neutrophil-to-lymphocyte ratio, white cell count, lymphocyte count, and monocyte count of value in the prediction of a pCR in the neoadjuvant treatment of breast cancer. Further research is required to determine their value in specific breast cancer subtypes and to establish optimal cut-off values, before their adoption in clinical practice.
已发现全身炎症反应标志物在多种癌症中有预后作用，但它们在预测乳腺癌新辅助化疗反应中的价值尚不确定。进行了系统的文献回顾和荟萃分析以对此进行研究。
系统地检索电子数据库，以确定探讨新辅助治疗前乳腺癌患者循环全身炎症反应标志物的预测价值的研究。对三个或更多研究报告炎症标志物与 pCR 率相关的每个炎症标志物进行荟萃分析。结果数据以 OR 和 95%置信区间报告。
共纳入 49 项研究，其中 42 项适合进行荟萃分析。较低的预处理中性粒细胞与淋巴细胞比值与较高的 pCR 率相关（汇总 OR 1.66（95%置信区间 1.32 至 2.09）；P < 0.001）。较低的白细胞计数（OR 1.96（95%置信区间 1.29 至 2.97）；P = 0.002）和较低的单核细胞计数（OR 3.20（95%置信区间 1.71 至 5.97）；P < 0.001）也与 pCR 相关。较高的淋巴细胞计数与较高的 pCR 率相关（OR 0.44（95%置信区间 0.30 至 0.64）；P < 0.001）。
本研究发现，在预测乳腺癌新辅助治疗中的 pCR 方面，预处理中性粒细胞与淋巴细胞比值、白细胞计数、淋巴细胞计数和单核细胞计数有价值。在将其应用于临床实践之前，还需要进一步研究以确定其在特定乳腺癌亚型中的价值并确定最佳截断值。
