外周血NLR联合CD8^(+)T淋巴细胞对乳腺癌患者保乳术后复发的预测价值

Value of peripheral blood NLR combined with CD8^(+)T lymphocytes in predicting recurrence of breast cancer patients after breast-conserving surgery

目的分析外周血中性粒细胞与淋巴细胞比值(NLR)联合CD8^(+)T淋巴细胞对乳腺癌患者保乳术后复发的预测价值。方法选择宝鸡市妇幼保健院2016年2月至2019年2月就诊的乳腺癌患者106例,年龄(45.82±9.57)岁,肿瘤最大径(2.37±0.85)cm,所有患者均接受保乳手术治疗。术后随访5年,根据复发情况分为复发组与非复发组。对比复发组与非复发组外周血CD8^(+)、NLR水平及临床资料,分析乳腺癌保乳术后复发的影响因素,外周血CD8^(+)、NLR水平及二者联合对乳腺癌保乳术后复发的预测价值。采用t检验、χ^(2)检验、Fisher确切概率法,影响因素分析采用logistic回归模型。结果随访5年,106例患者中失访3例,随访率为97.17%(103/106),复发12例,复发率为11.65%(12/103),未复发91例(88.35%,91/103)。复发组外周血CD8^(+)水平低于非复发组[(23.17±3.36)%比(29.45±4.23)%],复发组外周血NLR水平高于非复发组[(2.64±0.39)比(1.72±0.24)],两组比较差异均有统计学意义(均P<0.05)。复发组淋巴结转移例数占比高于非复发组[58.33%(7/12)比24.18%(22/91)],复发组术后足程放疗、术后规范化疗例数占比低于非复发组[25.00%(3/12)比93.41%(85/91)、33.33%(3/12)比89.01%(81/91)],两组比较差异均有统计学意义(均P<0.05)。logistic回归分析结果显示,外周血CD8^(+)降低(OR=0.285,95%CI 0.125~0.647)、外周血NLR升高(OR=4.175,95%CI 1.835~9.796)、淋巴结转移(OR=5.013,95%CI 2.204~11.403)、术后无足程放疗(OR=0.255,95%CI 0.112~0.579)为乳腺癌保乳术后复发的影响因素(均P<0.05)。外周血CD8^(+)、NLR水平及二者联合预测乳腺癌保乳术后复发的曲线下面积(AUC)分别为0.799、0.844、0.905,二者联合的AUC更高(P<0.05)。结论外周血CD8^(+)T淋巴细胞、NLR可用于预测乳腺癌患者保乳术后复发,且二者联合的预测价值更高。

Objective To analyze the value of peripheral blood neutrophil to lymphocyte ratio(NLR)combined with CD8^(+)T lymphocytes in predicting the recurrence of breast cancer patients after breast-conserving surgery.Methods A total of 106 patients with breast cancer who visited Baoji Maternal and Child Health Hospital from February 2016 to February 2019 were selected.They were(45.82±9.57)years old.The mean maximum tumor diameter was(2.37±0.85)cm.All the patients received breast-conserving surgery,and were followed up for 5 years.According to the recurrence situation,the patients were divided into a non-recurrence group and a recurrence group.The levels of peripheral blood CD8^(+),NLR's,and clinical data were compared between the recurrence group and the non-recurrence group.The factors influencing the recurrence of breast cancer after breast conserving surgery were analyzed.The values of peripheral blood CD8^(+),NLR,and their combination in predicting the recurrence of breast cancer after breast conserving surgery were analyzed.t test,χ^(2) test,and Fisher exact probability method were used.The logistic regression model was used to analyzed the influencing factors.Results After 5 years'follow-up,3 of the 106 patients were lost to follow-up,and the follow-up rate was 97.17%(103/106).Of which,12 patients relapsed,and the recurrence rate was 11.65%(12/103);the remaining 91 patients did not relapse,and the recurrence rate was 88.35%(91/103).The level of peripheral blood CD8^(+)in the recurrence group was lower than that in the non-recurrence group[(23.17±3.36)%vs.(29.45±4.23)%];the peripheral blood NLR in the recurrence group was higher than that in the non-recurrence group[(2.64±0.39)vs.(1.72±0.24)];there were statistical differences between the two groups(both P<0.05).The proportion of the patients with lymph node metastasis in the recurrence group was higher than that in the non-recurrence group[58.33%(7/12)vs.24.18%(22/91);P<0.05];the proportions of the patients taking postoperative full-course radiotherapy and standard chemotherapy in the recurrence group were lower than those in the non-recurrence group[25.00%(3/12)vs.93.41%(85/91)and 33.33%(3/12)vs.89.01%(81/91);both P<0.05].The logistic regression analysis showed that peripheral blood CD8^(+)decrease(OR=0.285,95%CI 0.125-0.647),peripheral blood NLR increase(OR=4.175,95%CI 1.835-9.796),lymph node metastasis(OR=5.013,95%CI 2.204-11.403),and postoperative full-course radiotherapy(OR=0.255,95%CI 0.112-0.579)were the influential factors for breast cancer recurrence after breast conserving surgery(all P<0.05).The areas under the curves(AUC)of peripheral blood CD8^(+),NLR,and their combination in predicting breast cancer recurrence after breast preservation surgery were 0.799,0.844,and 0.905,respectively,and the AUC of the combination was higher(P<0.05).Conclusion Peripheral blood CD8^(+)T lymphocytes and NLR can be used to predict the recurrence of breast cancer patients after breast-conserving surgery,and the combined value is higher.