术前中性粒细胞与淋巴细胞比值预测前哨淋巴结1~2枚阳性早期乳腺癌非前哨淋巴结状态可行性

Preoperative neutrophil to lymphocyte ratio predicts the feasibility of non-sentinel lymph node status in 1-2 positive sentinel lymph nodes in early breast cancer

目的分析前哨淋巴结(sentinel lymph node,SLN)1~2枚阳性早期浸润性乳腺癌非前哨淋巴结(non-sentinel lymph node,NSLN)状态与术前中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)间的关系。方法回顾性分析2015年10月1日~2019年12月1日就诊于我院的SLN 1~2枚阳性,且进一步腋窝清扫早期浸润性乳腺癌病人的临床病理指标及术前血常规资料。通过受试者工作曲线及曲线下面积评估NLR应用价值。采用单因素及多因素分析临床病理指标及术前NLR与NSLN状态关系。结果符合纳入标准213例。NLR最佳截断值为1.8,曲线下面积0.718,灵敏度68.7%,特异度73.1%。单因素分析发现,Her-2状态、SLN转移比值及NLR与NSLN状态相关(P<0.05)。多因素分析显示,SLN转移比值(SLN转移比值R=1、0.5≤R<1比较SLN转移比值R<0.05的OR分别为6.756、1.891,和NLR(OR:6.154,95%CI:3.130~12.100,P<0.05)是NSLN状态独立预测因子。结论术前NLR是NSLN状态有效预测指标,但需要进一步研究证实其临床应用价值。

Objective This study analyzed the relationship between the sentinel lymph node(SLN) 1-2 positive early invasive breast cancer non-sentinel lymph node(NSLN) status and preoperative neutrophil-to-lymphocyte ratio(NLR).Method A retrospective analysis of the clinicopathological indicators and preoperative blood routine data of patients with positive SLN1-2 positive and further axillary dissection for early invasive breast cancer who were admitted to the Affiliated Cancer Hospital of Zhengzhou University from October 1,2015 to December 1,2019.The NLR application value was evaluated by the receiver working curve and the area under the curve.Univariate and multivariate analysis was used to analyze the clinicopathological indicators and the relationship between preoperative NLR and NSLN status.Result A total of 213 cases met the inclusion criteria.The best cut-off value of NLR is 1.8,the area under the curve is 0.718,the sensitivity is 68.7%,and the specificity is 73.1%.Univariate analysis found Her-2 status,SLN positive ratio and NLR and NSLN status(P<0.05),multivariate analysis showed SLN positive ratio(SLN positive ratio R=1,0.5≤R<1 compared with SLN positive ratio R<0.05 OR were 6.756 and 1.891,respectively,with NLR(OR:6.154,95% CI:3.130-12.100,P<0.001) were independent predictors of NSLN.Conclusion Preoperative NLR is an effective predictor of NSLN status,but further research is needed to confirm its clinical value.