术前NLR对浸润性乳腺癌腋窝淋巴结转移预测价值研究

Predictive value of preoperative NLR for axillary lymphnode metastasis in invasive breast cancer

目的 探讨术前系统性炎性指标中中性粒细胞与淋巴细胞比值(Neutrophil to lymphocyte ratio, NLR)与浸润性乳腺癌(IBC)腋窝淋巴结转移的关系,为乳腺癌临床预后判断及相关诊治提供实验参考。方法 收集2017年1月-2023年5月南昌市第三医院收治的96例浸润性乳腺患者的临床病理资料及系统性炎症指标结果,根据病理诊断结果将其分为腋窝淋巴结转移组(转移组,44例)和无腋窝淋巴结转移组(无转移组,52例)两组,并对两组病例所对应的系统性炎症指标进行比较分析,根据结果进行logistic相关性分析,通过应用受试者工作曲线(Receiver operating characteristic, ROC)得出最佳临界值,并分析后者与相关临床病理参数的关联。结果 浸润性乳腺癌患者中,相较于无转移组,转移组NLR更高,且该组的年龄更小,两项指标之间有统计学差异(P<0.05)。两组患者其他系统性炎症指标对比差异无统计学意义(P>0.05)。在这类癌症病人中,logistic相关性分析NLR升高与腋窝淋巴结转移相关;由ROC曲线分析得出,预测腋窝淋巴结转移的NLR最佳临界值为2.65,且其相应的灵敏度和特异度分别为62.5%、92.1%;同时还确定出曲线下面积(AUC)为0.748。NLR值高低与浸润性乳腺癌患者的临床病理相关参数ER、PR、P53、HER2以及分子分型之间没有相关性(P>0.05)。结论 系统性炎性指标中,NLR升高是浸润性乳腺癌患者腋窝淋巴结转移的风险因子,预示更差的预后。

Objective To explore the relationship between the preoperative of neutrophils-to-lymphocytes ratio(NLR)of systemic inflammatory markers and axillary lymph node metastasis in invasive breast cancer(IBC),providing experimental evidence for clinical prognosis and treatment.Methods Clinical and pathological data of 96 patients with invasive breast carcinoma admitted to Nanchang Third Hospital from January 2017 to May 2023 were collected.Patients were divided into two groups based on pathological findings:axillary lymph node metastasis group(metastasis group,44 cases)and non-axillary lymph node metastasis group(non-metastasis group,52 cases).Systemic inflammatory markers were compared and analyzed between the two groups.Logistic regression analysis was performed to establish a diagnostic model,and the receiver operating characteristic(ROC)curve was used to determine the optimal cutoff value for predicting axillary lymph node metastasis in breast cancer.The correlation between this value and related clinical and pathological parameters was analyzed.Results In patients with invasive breast cancer,the NLR was higher in the metastasis group compared to the non-metastasis group,and the former was younger,with both differences being statistically significant(P<0.05).No significant differences were observed in other systemic inflammatory markers between the two groups(P>0.05).Logistic regression analysis indicated that an elevated NLR was associated with axillary lymph node metastasis.The ROC curve analysis revealed that the optimal cutoff value for NLR in predicting axillary lymph node metastasis was 2.65,with a sensitivity of 62.5%and a specificity of 92.1%.The area under the curve(AUC)was 0.748.No correlation was found between NLR values and clinical and pathological parameters such as ER,PR,P53,HER2,and molecular subtypes in patients with invasive breast cancer(P>0.05).Conclusions Among systemic inflammatory markers,the increase of NLR is a risk factor for axillary lymph node metastasis,and predicts a worse prognosis in patients with invasive breast cancer.