外周血淋巴细胞和单核细胞比值对三阴性乳腺癌新辅助化疗疗效的预测价值

Predictive value of peripheral blood lymphocyte-to-monocyte ratio on efficacy of neoadjuvant chemotherapy for triple negative breast cancer

目的:探讨外周血淋巴细胞和单核细胞比值(lymphocyte-to-monocyte ratio, LMR)对三阴性乳腺癌(triple negative breast cancer, TNBC)患者新辅助化疗(neoadjuvant chemotherapy, NAC)疗效的预测价值。方法:收集2017年01月至2019年12月在我院接受NAC治疗的100例TNBC患者,均行NAC治疗并观察近期疗效,行外周血LMR的检测,采用受试者工作特征(receiver operating characteristic, ROC)曲线确定LMR的截断值,将患者分为高LMR组与低LMR组,探究化疗前外周血LMR与NAC疗效的关系。结果:100例TNBC患者,NAC治疗有效率为74.00%(74/100),其中CR 6例,PR 68例;临床无效率为26.00%(26/100),其中PD 24例,SD 2例。ROC曲线分析显示,外周血LMR预测NAC疗效的曲线下面积为0.884 (95%CI:0.805~0.939),截断值为4.56。单因素分析显示,NAC疗效与年龄(χ^(2)=0.661,P=0.416)、T分期(χ^(2)=3.774,P=0.052)、淋巴结转移(χ^(2)=0.674,P=0.412)、临床分期(χ^(2)=0.630,P=0.427)均无相关性,而与Ki-67水平(χ^(2)=6.971,P=0.008)、LMR值(χ^(2)=10.695,P=0.001)具有相关性。Ki-67高表达组NAC化疗有效率(84.91%)高于低表达组(61.70%),高LMR组(>4.56)的化疗有效率(86.21%)高于低LMR组(≤4.56)的化疗有效率(57.14%),差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,高LMR水平(OR=0.286,95%CI:0.105~0.781)及Ki-67高表达(OR=0.328,95%CI:0.129~0.834)均是TNBC患者NAC疗效的有利因素(P<0.05)。结论:外周血LMR对TNBC患者NAC疗效有预测价值,高LMR水平可能提示疗效较好。

Objective:To investigate the predictive value of peripheral blood lymphocyte-to-monocyte ratio(LMR) on efficacy of neoadjuvant chemotherapy(NAC) for patients with triple negative breast cancer(TNBC).Methods:A total of 100 TNBC patients who received NAC treatment in our hospital from January 2017 to December 2019 were collected.All patients were treated with NAC,and the short-term efficacy was observed.The peripheral blood LMR was detected, and receiver operating characteristic curve was used to determine the cutoff value of LMR.The patients were divided into the high LMR group and the low LMR group, and the relationship between peripheral blood LMR before chemotherapy and NAC efficacy was explored.Results: Among 100 TNBC patients, the effective rate of NAC treatment was 74. 00%(74/100),including 6 cases of CR and 68 cases of PR. The clinical ineffective rate was 26. 00%(26/100),including 24 cases of PD and 2 cases of SD. ROC curve analysis showed that the area under the curve of peripheral blood LMR in predicting the efficacy of NAC was 0. 884(95% CI:0. 805 ~ 0. 939),and the cutoff value was 4. 56. Univariate analysis showed that NAC efficacy was not correlated with age(χ^(2)= 0. 661,P=0. 416),T stage(χ^(2)= 3. 774,P= 0. 052),lymph node metastasis ( χ^(2)= 0. 674,P= 0. 412 ) and clinical stage(χ^(2)= 0. 630,P= 0. 427),but was correlated with the Ki-67 level(χ^(2)= 6. 971,P= 0. 008) and LMR value(χ^(2)=10. 695,P= 0. 001). The chemotherapy effective rate of the high Ki-67 expression group was higher than that of the low expression group(84. 91% vs 61. 70%),and the chemotherapy effective rate of the high LMR group( > 4. 56)was higher than that of the low LMR group(≤4. 56)(86. 21% vs 57. 14%)(P< 0. 05). Multivariate Logistic regression analysis showed that high LMR level(OR = 0. 286,95% CI:0. 105 ~ 0. 781) and high Ki-67 expression(OR =0. 328,95% CI:0. 129 ~ 0. 834) both were beneficial factors for NAC efficacy of TNBC patients(P< 0. 05).Conclusion:Peripheral blood LMR has predictive value on NAC efficacy in TNBC patients,and high LMR level may indicate better efficacy.