外周血淋巴细胞和单核细胞比值与乳腺癌新辅助化疗疗效关联性

目的新辅助化疗(neoadjuvant chemotherapy,NAC)已成为局部晚期乳腺癌的标准治疗选择,然而化疗前缺乏有效的疗效预测评估手段。部分研究表明,外周血淋巴细胞与单核细胞比值(lymphocyte-monocyte ratio,LMR)与多种癌症的预后相关。本研究探讨化疗前外周血LMR对乳腺癌新辅助化疗疗效的预测价值。方法收集西南医科大学乳腺外科2018-01-31—2019-03-08接受新辅助化疗后可确认手术切除的55例女性乳腺癌患者资料,采用受试者工作曲线,将约登指数最大值对应的外周血LMR作为截断值,分为高、低比值组。并采用乳腺癌新辅助化疗后组织学评估评价系统(Miller-Payne分级系统)评价术后乳腺癌组织的病理治疗反应,统计分析两者间的关系。结果NAC疗效与肿瘤大小(χ^2=0.007,P=0.931)、淋巴结转移情况(χ^2=2.208,P=0.154)、组织分级(χ^2=0.931,P=0.335)、临床分期(χ~2=0.026,P=0.871)、病理分型(χ^2=5.519,P=0.063)、Ki-67水平(χ^2=0.004,P=0.953)无关联性;仅与LMR比值有关联性,外周血LMR高比例组(≥4.87)的新辅助化疗有效率为90.6%,高于低比例组(<4.87)的43.5%,差异有统计学意义,χ^2=14.420,P<0.001。多因素Logistic回归分析显示,化疗前高LMR是影响新辅助化疗的保护性因素,OR=0.073,95%CI为0.016~0.333,P=0.001。结论化疗前高外周血LMR患者新辅助化疗疗效可能更佳。

Correlation between the peripheral blood lymphocyte-monocyte ratio and the curative effect receiving neoadjuvant chemotherapy

OBJECTIVE Neoadjuvant chemotherapy(NAC)is a standard treatment option for locally advanced breast cancer.However,there are still lack of efficient methods to predict treatment response before neoadjuvant chemotherapy.Several reports have suggested that lymphocyte-monocyte ratio is associated with prognosis in some tumors.In this study,we evaluated the predictive value of lymphocyte-monocyte ratio(LMR)for chemosensitivity in breast cancer patients who received NAC.METHODS We analyzed the clinical data of 55 breast cancer patients with NAC in the Affiliated Hospital of Southwest Medical University from January 31,2018 to March 8,2019,Cutoff values of LMR were estimated by Yoden index,and the patients were divided into high or low ratio group according to cutoff values.The response to neoadjuvant chemotherapy was evaluated using the histopathological criteria for assessment of therapeutic response in breast cancer.The relation between LMR and response to neoadjuvant chemotherapy was analyzed.RESULTS Patients with a higher LMR(≥4.87)were more likely to achieve a better response to neoadjuvant chemotherapy than those with a lower LMR(<4.87;90.6%vs 43.5%;χ^2=14.420,P<0.001).The LMR,but not tumor size(χ^2=0.007,P=0.931),lymph node status(χ^2=2.208,P=0.154),histologic grade(χ^2=0.931,P=0.335),clinical stage(χ^2=0.026,P=0.871),molecular types(χ^2=5.519,P=0.063),or Ki-67 index(χ^2=0.004,P=0.953),was correlated with response to neoadjuvant chemotherapy.Multivariate logistic regression analysis showed that high LMR was an independent predict factor in breast cancer patients with NAC(OR:0.073,95%CI:0.016-0.333,P=0.001).CONCLUSION High LMR in peripheral blood of breast cancer patients may achieve better response to neoadjuvant chemotherapy than those exhibiting lower LMR.