国际肿瘤学杂志

国际肿瘤学杂志 ›› 2022, Vol. 49 ›› Issue (4): 210-215.doi: 10.3760/cma.j.cn371439-20210813-00037

• 论著 • 上一篇    下一篇

治疗前全身炎症反应指数对乳腺癌新辅助化疗病理完全缓解的预测价值

刘永红1, 薛玲博1, 白杨1, 靳健1, 臧春霞2, 张博1, 李杰1()   

  1. 1河北省沧州市中心医院甲状腺乳腺外四科,沧州 061000
    2河北省沧州市中心医院甲状腺乳腺外一科,沧州 061000
  • 收稿日期:2021-08-13 修回日期:2022-01-09 出版日期:2022-04-08 发布日期:2022-05-11
  • 通讯作者: 李杰 E-mail:lj13513279709@hotmail.com
  • 基金资助:
    沧州市科学计划自筹经费项目(183302024)

Predictive value of systemic inflammation response index before treatment for pathological complete response in patients with breast cancer undergoing neoadjuvant chemotherapy

Liu Yonghong1, Xue Lingbo1, Bai Yang1, Jin Jian1, Zang Chunxia2, Zhang Bo1, Li Jie1()   

  1. 1Fourth Department of Thyroid and Breast Surgery, Cangzhou Central Hospital of Hebei Province, Cangzhou 061000, China
    2First Department of Thyroid and Breast Surgery, Cangzhou Central Hospital of Hebei Province, Cangzhou 061000, China
  • Received:2021-08-13 Revised:2022-01-09 Online:2022-04-08 Published:2022-05-11
  • Contact: Li Jie E-mail:lj13513279709@hotmail.com
  • Supported by:
    Cangzhou Self-funded Project of Science Program of China(183302024)

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摘要：

目的 探讨治疗前全身炎症反应指数（SIRI）对乳腺癌新辅助化疗病理完全缓解（pCR）的预测价值。方法 回顾性分析2010年1月至2020年3月河北省沧州市中心医院确诊并接受新辅助化疗和乳腺癌保乳或改良根治术的119例原发性乳腺癌患者的临床资料,根据患者的术后病理分为pCR组（n=19）和非pCR组（n=100）。比较两组患者治疗前SIRI。依据治疗前SIRI分为SIRI≤0.25（n=10）、0.26~0.50（n=42）、0.51~0.75（n=29）、0.76~1.00（n=19）及>1.00（n=19）共5组,比较5组患者的pCR率。通过Spearman相关性分析评估治疗前SIRI与pCR的相关性,采用logistic回归分析乳腺癌患者新辅助化疗pCR的影响因素,受试者工作特征（ROC）曲线评估治疗前SIRI对乳腺癌新辅助化疗pCR的预测价值。结果 pCR和非pCR两组患者在肿瘤大小（Z=2.26,P=0.024）、腋窝淋巴结转移（χ2=5.73,P=0.017）、人表皮生长因子受体-2（HER-2）（χ2=8.77,P=0.003）、Ki-67（Z=2.68,P=0.007）、细胞学核分级（χ2=5.08,P=0.024）、治疗前中性粒细胞计数（Z=2.44,P=0.015）、治疗前单核细胞/淋巴细胞计数比值（Z=3.04,P=0.002）及治疗前SIRI（Z=3.29,P=0.001）方面差异均具有统计学意义。治疗前SIRI≤0.25组的pCR率为50%（5/10）,0.26~0.50组为21%（9/42）,0.51~0.75组为10%（3/29）,0.76~1.00组为11%（2/19）,>1.00组为0（0/19）,差异具有统计学意义（χ2=14.28,P=0.006）。患者治疗前SIRI与pCR呈负相关（r=-0.30,P=0.001）。单因素logistic回归分析显示,肿瘤大小（OR=0.50,95%CI为0.28~0.89,P=0.019）、腋窝淋巴结转移（OR=5.43,95%CI为1.19~24.83,P=0.029）、HER-2（OR=7.54,95%CI为1.65~34.36,P=0.009）、Ki-67（OR=1.03,95%CI为1.01~1.05,P=0.008）、细胞学核分级（OR=0.20,95%CI为0.04~0.92,P=0.038）、治疗前中性粒细胞计数（OR=0.54,95%CI为0.32~0.92,P=0.023）、治疗前单核细胞/淋巴细胞计数比值（OR=0.00,95%CI为0.00~0.01,P=0.007）及治疗前SIRI（OR=0.03,95%CI为0.00~0.37,P=0.007）为乳腺癌患者新辅助化疗pCR的影响因素。多因素logistic回归分析显示,肿瘤大小（OR=0.31,95%CI为0.14~0.72,P=0.007）、腋窝淋巴结转移（OR=10.97,95%CI为1.35~89.61,P=0.025）、HER-2（OR=6.47,95%CI为1.18~35.65,P=0.032）、Ki-67（OR=1.04,95%CI为1.00~1.07,P=0.029）、细胞学核分级（OR=7.87,95%CI为1.01~61.35,P=0.049）及治疗前SIRI（OR=0.03,95%CI为0.00~0.58,P=0.020）为乳腺癌患者新辅助化疗pCR的独立影响因素。ROC曲线分析显示,治疗前SIRI预测乳腺癌新辅助化疗pCR的曲线下面积为0.74（95%CI为0.65~0.82）,敏感性为68.0%,特异性为75.3%;治疗前单核细胞/淋巴细胞计数比值预测pCR的曲线下面积为0.72（95%CI为0.63~0.80）,敏感性为48.0%,特异性为84.2%;治疗前中性粒细胞计数预测pCR的曲线下面积为0.68（95%CI为0.59~0.76）,敏感性为61.0%,特异性为83.7%。结论 治疗前SIRI可用于预测乳腺癌患者新辅助化疗pCR,SIRI低的患者更易获得pCR。

关键词: 乳腺肿瘤, 新辅助化疗, 炎症

Abstract:

Objective To investigate the predictive value of systemic inflammation response index （SIRI） before treatment for pathological complete response （pCR） in patients with breast cancer undergoing neoadjuvant chemotherapy. Methods The clinicopathological data of 119 patients with primary breast cancer undergoing neoadjuvant chemotherapy and subsequent breast-conserving or modified radical surgery from Cangzhou Central Hospital of Hebei Province between January 2010 to March 2020 were retrospectively analyzed, and patients were divided into pCR group （n=19） and non-pCR group （n=100） based on postoperative pathology. The SIRI before treatment between the two groups was compared. The patients were divided into SIRI≤0.25 （n=10）, 0.26-0.50 （n=42）, 0.51-0.75 （n=29）, 0.76-1.00 （n=19）, and >1.00 （n=19） groups according the SIRI before treatment, and the pCR ratios of the five groups were compared. Spearman correlation analysis was applied to evaluate the relationship between SIRI before treatment and pCR, logistic regression analysis was used to identify the influencing factors of pCR for neoadjuvant chemotherapy in breast cancer patients, and receiver operating characteristic （ROC） curve was used to evaluate the predictive value of SIRI before treatment for pCR of neoadjuvant chemotherapy in breast cancer patients. Results Tumor size （Z=2.26, P=0.024）, axillary lymph node metastasis （χ2=5.73, P=0.017）, human epidermal growth factor receptor-2 （HER-2） （χ2=8.77, P=0.003）, Ki-67 （Z=2.68, P=0.007）, cytological nuclear grade （χ2=5.08, P=0.024）, neutrophil count before treatment （Z=2.44, P=0.015）, monocyte/lymphocyte ratio before treatment （Z=3.04, P=0.002）, and SIRI before treatment （Z=3.29, P=0.001） had statistical differences between the pCR and non-pCR groups. The pCR ratios were 50% （5/10） in the SIRI ≤0.25 group, 21% （9/42） in the 0.26-0.50 group, 10% （3/29） in the 0.51-0.75 group, 11% （2/19） in the 0.76-1.00 group, and 0 （0/19） in the >1.00 group, with a statistic difference （χ2=14.28, P=0.006）. SIRI before treatment was negatively related with pCR （r=-0.30, P=0.001）. Univariate logistic regression analysis showed that tumor size （OR=0.50, 95%CI： 0.28-0.89, P=0.019）, axillary lymph node metastasis （OR=5.43, 95%CI： 1.19-24.83, P=0.029）, HER-2 （OR=7.54, 95%CI： 1.65-34.36, P=0.009）, Ki-67 （OR=1.03, 95%CI： 1.01-1.05, P=0.008）, cytological nuclear grade （OR=0.20, 95%CI： 0.04-0.92, P=0.038）, neutrophil count before treatment （OR=0.54, 95%CI： 0.32-0.92, P=0.023）, monocyte/lymphocyte ratio before treatment （OR=0.00, 95%CI： 0.00-0.01, P=0.007）, and SIRI before treatment （OR=0.03, 95%CI： 0.00-0.37, P=0.007） were influencing factors for pCR of neoadjuvant chemotherapy in breast cancer patients. Multivariate logistic regression analysis confirmed that tumor size （OR=0.31, 95%CI： 0.14-0.72, P=0.007）, axillary lymph node metastasis （OR=10.97, 95%CI： 1.35-89.61, P=0.025）, HER-2 （OR=6.47, 95%CI： 1.18-35.65, P=0.032）, Ki-67 （OR=1.04, 95%CI： 1.00-1.07, P=0.029）, cytological nuclear grade （OR=7.87, 95%CI： 1.01-61.35, P=0.049）, and SIRI before treatment （OR=0.03, 95%CI： 0.00-0.58, P=0.020） were independent influencing factors for pCR of neoadjuvant chemotherapy in breast cancer patients. The ROC curve showed that the area under the curve of SIRI before treatment for predicting pCR was 0.74 （95%CI： 0.65-0.82）, sensitivity was 68.0%, and specificity was 75.3%. The area under the curve of monocyte/lymphocyte ratio before treatment for predicting pCR was 0.72 （95%CI： 0.63-0.80）, sensitivity was 48.0%, and specificity was 84.2%. The area under the curve of neutrophil count before treatment for predicting pCR was 0.68 （95%CI： 0.59-0.76）, sensitivity was 61.0%, and specificity was 83.7%. Conclusion SIRI before treatment may serve as a marker for predicting pCR in patients with breast cancer undergoing neoadjuvant chemotherapy,patients with low SIRI are more likely to obtain pCR.

Key words: Breast neoplasms, Neoadjuvant chemotherapy, Inflammation