外周血多项指标预测乳腺癌新辅助化疗疗效的价值-现代医学

外周血多项指标预测乳腺癌新辅助化疗疗效的价值

单位：甘肃省妇幼保健院, 甘肃兰州 730050

分类号：R737.9

出版年·卷·期（页码）：2023·51·第五期（649-655）

摘要：

目的：探讨乳腺癌患者新辅助化疗(NAC)前外周血单核细胞与红细胞比值(MRR)、免疫炎症指数(SII)、血浆纤维蛋白原(FIB)、D-二聚体(D-Dimer)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)在NAC疗效评估中的价值。方法：回顾性分析2019年12月至2022年10月于我院确诊并接受NAC的152例乳腺癌患者的临床资料，以病理完全缓解(pCR)作为NAC疗效的评判指标，并对化疗前MRR、SII、FIB、D-Dimer、TC及HDL-C水平与pCR的相关性进行单因素和多因素分析。结果：152例患者中，有60例(39.47%) 接受NAC后达到pCR。单因素和多因素分析显示，患者的年龄、肿瘤大小、临床分期、分子分型、Ki-67、雄激素受体(AR)、表皮生长因子受体(EGFR)、细胞角蛋白5/6(CK5/6)、P53及MRR水平与NAC后是否达到pCR无明显相关性(P＞0.05)。Logistic回归分析显示，化疗前外周血D-Dimer水平及人表皮生长因子受体2(HER-2)表达与是否达到pCR显著相关(P＜0.05)，低D-Dimer组患者达到pCR率显著高于高D-Dimer组(P＝0.008，95%CI为0.001～0.365)；而SII、FIB、TC及HDL-C水平与是否达到pCR无明显相关性(P＞0.05)。结论：乳腺癌患者NAC前外周血D-Dimer水平与NAC后是否达到pCR显著相关，这对局部晚期乳腺癌NAC治疗有一定的指导价值。

Objective: To investigate the peripheral blood monocyte to red blood cell ratio(MRR), systemic immunoinflammatory index(SII), plasma fibrinogen(FIB), D-Dimer, total cholesterol(TC) and the value of high density lipoprotein cholesterol(HDL-C) in the evaluation of neoadjuvant chemotherapy(NAC) efficacy. Methods: The clinical data of 152 patients with breast cancer who were diagnosed and received NAC in our hospital from December 2019 to October 2022 were retrospectively studied. Pathological complete response(pCR) was used as the evaluation index of NAC efficacy. The correlation between the levels of MRR, SII, FIB, D-Dimer, TC and HDL-C and the pCR before chemotherapy was analyzed by univariate and multivariate analysis. Results: Among the 152 patients with breast cancer, 60 patients(39.47%) achieved pCR after receiving NAC. Univariate and multivariate analyses showed that the age, tumor size, clinical stage, molecular classification, Ki-67, AR, EGFR, CK5/6, P53 and MRR levels of the patients had no significant correlation with whether they achieved pCR after NAC(P＞0.05). Logistic regression analysis showed that the levels of D-Dimer in peripheral blood before chemotherapy were significantly related to pCR(P＜0.05). The rate of achieving pCR in patients with low D-Dimer was significantly higher than that in patients with high D-Dimer(P=0.008, 95%CI 0.001-0.365); however, SII, FIB, TC and HDL-C levels were not significantly correlated with pCR(P＞0.05). Conclusion: D-Dimer level expressions in peripheral blood of breast cancer patients before NAC are significantly related to pCR after NAC, which has certain guiding value for NAC treatment of locally advanced breast cancer.

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