PLR As A Predictive Factor Of PCR In Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

BackgroundBreast cancer is one of the most common malignant tumors in women,since the late 1970 s,the prevalence of breast cancer has been increasing year by year,and the number of cases has been increasing,seriously affecting and threatening women’s quality of life and physical health.Breast cancer originates from the breast epithelial tissue,accounting for 23% of all malignancies.According to the immunohistochemistry,breast cancer is divided into 4 subtypes: luminal type A,luminal type B,Her-2 overexpressed and basal-like breast cancer.In addition to surgery,the treatment of breast cancer includes chemotherapy,hormonal therapy,radiotherapy,targeted treatment and so on,in which chemotherapy is divided into adjuvant chemotherapy and neoadjuvant chemotherapy.Neoadjuvant chemotherapy refers to the treatment of systemic cytotoxic drugs before surgery for non-distant metastatic tumors.It can not only reduce the clinical stage of tumor,improve the rate of radical surgery or preservation rate in breast cancer patients,but also play the role of drug sensitivity test,thus guiding clinical drug use.For breast cancer patients,pathologic complete response(pCR)after neoadjuvant chemotherapy has clear value in short-and medium-term prognosis and is one of the main objectives currently to assess the potential benefits of new complementary chemotherapy.And some studies suggest that pCR can be used as an alternative endpoint for disease-free survival(DFS),event-free survival(EFS)and overall survival(OS)in predicting long-term clinical benefits.The biological behavior of malignant tumor is closely related to the activation of the body’s inflammatory response,and inflammation and immunity play an important role in tumor occurrence,development and metastasis.Among them,nonspecific systemic inflammatory indicators—platelet-lymphocytic ratio can sensitively reflect the body’s inflammatory response state,and is associated with the progression of many malignant tumors such as breast cancer,nasopharyngeal cancer,prostate cancer,colon cancer,esophageal cancer,ovarian cancer,liver cancer and stomach cancer.ObjectiveTo assess the relationship between peripheral blood platelet-to-lymphocyte ratio(PLR)and pathologic complete response(pCR)in the breast cancer treated with neoadjuvant chemotherapy.MethodsThe clinical data of 242 patients with breast cancer diagnosed and accepted neoadjuvant chemotherapy retrospectively analyzed in the First Affiliated Hospital of Zhengzhou University from January 2013 to June 2018.The PLR value corresponding to the maximum value of Yoden index was regarded as cutoff value,and the patients was divided into high and low ratio groups according to the cutoff value.Chi-square test and logistic regression model were used to analyze the relationship between PLR level in peripheral blood and pCR level before neoadjuvant chemotherapy in the patients with breast cancer.Results1.The PLR value corresponding to the maximum of Yoden index was 146.7,regarded as cutoff values.2.There were 48 patients in the high PLR group(>146.7)and 194 patients in the low PLR group(≤146.7).In this study,90 patients(37.2%)achieved pCR.The highest pCR rate was found in 46 patients(65.7%)with triple negative and 18 patients(33.3%)with Her-2 enriched.3.Chi-square test analysis showed that tumor grade,estrogen receptor status,progesterone receptor status,biological subtype and PLR value were significantly correlated with pCR in the patients with breast cancer after neoadjuvant chemotherapy.4.Logistic regression analysis model showed that tumor grade,biological subtype and PLR value were significantly correlated with pCR in the patients with breast cancer after neoadjuvant chemotherapy.The pCR rate of patients with breast cancer after neoadjuvant chemotherapy in the low PLR group was significantly higher than that in the high PLR group(OR = 0.450,95% CI =0.204-0.995,P = 0.048).ConclusionPLR is an independent predictor of whether patients with breast cancer achieve pCR after neoadjuvant chemotherapy,and it can be used as an effective prognostic indicator of breast cancer.