Is the Platelet-Lymphocyte Ratıo a Useful Tool for Predicting Sentinel Lymph Node Metastasıs in Breast Cancer Patients Receiving Neoadjuvant Therapy?

Year 2022, Volume: 13 Issue: 3, 352 - 359, 27.09.2022

Serdar Culcu , Elifcan Haberal , Selim Tamam , Cemil Yuksel , Bulent Aksel , Lütfi Doğan

https://doi.org/10.18663/tjcl.1147959

Abstract

Amaç:
Meme kanseri kadınlarda morbidite ve mortalitesi en yüksek kanserlerden biridir. Aksiller lenf nodlarının cerrahi olarak çıkarılması, aksiller metastazı olanlarda evrelemeyi kolaylaştırır ve bölgesel kontrol sağlar. Primer cerrahi uygulanan cN0 hastalığı olan hastaların yönetiminde SLNB rutin olarak yapılsa da neoadjuvan kemoterapi alan hastalarda SLNB’ nin ne zaman yapılacağı tartışmalıdır. Çalışmamızda neoadjuvan tedavi alan meme kanserli hastalarda neoadjuvan tedavi öncesi ve sonrası trombosit/lenfosit oranının sentinel lenf nodu metastazlarını öngörmedeki başarısını değerlendirdik.
Gereç ve Yöntemler:
Kliniğimizde lokal ileri meme kanseri nedeniyle neoadjuvan kemoterapi almış hastalar değerlendirildi. Bu hastalar arasından, aksilla metastazı histopatolojik olarak kanıtlanmış fakat neoadjuvan tedavi sonrası klinik muayenede ve görüntüleme yöntemlerinde patolojik lenf nodu izlenmeyen hastalar değerlendirildi.
Bulgular:
Sentinel lenf nodu örneklemesi için ortalama 3.81 adet lenf nodu eksizyonu yapıldı. PLR cut-off değerini Roc-curve analiz ile çalıştık. 0.061 standart hata ile cut-off değerini 138.88 bulduk (p=0.001). PLR yüksek olan hastalarda sentinel lenf nodunda metastaz olma olasılığı, PLR düşük olan hastalara göre daha yüksektir (OR= 1.013, 95%Cl: 1.005-1.021, p=0.002). Ayrıca PLR ile metastatik sentinel lenf nodu sayısı arasında da pozitif yönde anlamlı ilişki bulduk (p=0.005). PLR’de her bir birim artışı, metastatik sentinel lenf nodu sayısında 0.004 birim artışa neden olabilmektedir.
Sonuç:
Neoadjuvan kemoterapi alan hastalarda PLR pratik, basit ve ucuz bir hematolojik gösterge olarak sentinel lenf nodu metastazını tahmin etmede önemli bir rol oynar ve cerrahi öncesi uygun tedavi planı seçimini kolaylaştırabilir.

Keywords

Sentinel Lymph Node, breast cancer, inflammatory parameters

Is the Platelet-Lymphocyte Ratıo a Useful Tool for Predicting Sentinel Lymph Node Metastasıs in Breast Cancer Patients Receiving Neoadjuvant Therapy?

Abstract

Aim: Breast cancer is one of the cancers with the highest morbidity and mortality in women. Surgical excision of axillary lymph nodes facilitates staging and provides regional control in those with axillary metastases. Although SLNB is routinely performed in the management of patients with cN0 disease who underwent primary surgery, it is controversial when to perform SLNB in patients receiving neoadjuvant chemotherapy. In our study, we evaluated the success of the platelet/lymphocyte ratio before and after neoadjuvant therapy in predicting sentinel lymph node metastases in breast cancer patients receiving neoadjuvant therapy.

Materials-Methods: Patients who received neoadjuvant chemotherapy for locally advanced breast cancer in our clinic were evaluated. Among these patients, patients with histopathologically proven axilla metastases but no pathological lymph nodes in clinical examination and imaging methods after neoadjuvant therapy were evaluated.

Results: An average of 3.81 lymph node excisions were performed for sentinel lymph node sampling. We studied the PLR cut-off value with Roc-curve analysis. We found the cut-off value of 138.88 with a standard error of 0.061 (p=0.001). Patients with high PLR are more likely to have sentinel lymph node metastases than patients with low PLR (OR= 1.013, 95%Cl: 1.005-1.021, p=0.002). We also found a significant positive correlation between PLR and the number of metastatic sentinel lymph nodes (p=0.005). Each unit increase in PLR can cause an increase of 0.004 units in the number of metastatic sentinel lymph nodes.
Conclusion: In patients receiving neoadjuvant chemotherapy, PLR plays an important role in predicting sentinel lymph node metastasis as a practical, simple, and inexpensive hematological indicator and may facilitate the selection of an appropriate treatment plan before surgery.
Keywords: Sentinel lymph node, Breast cancer, inflammatory parameters

Keywords

Sentinel lymph node, Breast cancer, inflammatory parameters

References

• 1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10.3322/caac.21660
• 2. Chagpar AB, Martin RC, Scoggins CR, et al. Factors predicting failure to identify a sentinel lymph node in breast cancer. Surgery. 2005;138(1):56-63. doi:10.1016/j.surg.2005.03.003
• 3. Straver ME, Meijnen P, van Tienhoven G, et al. Sentinel node identification rate and nodal involvement in the EORTC 10981-22023 AMAROS trial. Ann Surg Oncol. 2010;17(7):1854-1861. doi:10.1245/s10434-010-0945-z
• 4. Krag DN, Anderson SJ, Julian TB, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol. 2007;8(10):881-888. doi:10.1016/S1470-2045(07)70278-4
• 5. Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow?. Lancet. 2001;357(9255):539-545. doi:10.1016/S0140-6736(00)04046-0
• 6. Betsholtz C, Johnsson A, Heldin CH, Westermark B, Lind P, Urdea MS, Eddy R, Shows TB, Philpott K, Mellor AL et al: Cdna sequence and chromosomal localization of human plateletderived growth factor a-chain and its expression in tumour cell lines. Nature 320(6064): 695-699, 1986. PMID: 3754619. DOI: 10.1038/320695a0
• 7. Ross R, Masuda J, Raines EW, Gown AM, Katsuda S, Sasahara M, Malden LT, Masuko H and Sato H: Localization of pdgf-b protein in macrophages in all phases of atherogenesis. Science 248(4958): 1009-1012, 1990. PMID: 2343305. DOI: 10.1126/science.2343305
• 8. Heldin CH and Westermark B: Growth factors: Mechanism of action and relation to oncogenes. Cell 37(1): 9-20, 1984. PMID: 6373015. DOI: 10.1016/0092-8674(84)90296-4
• 9. Miyazono K, Yuki K, Takaku F, Wernstedt C, Kanzaki T, Olofsson A, Hellman U and Heldin CH: Latent forms of tgf-beta: Structure and biology. Ann NY Acad Sci 593: 51-58, 1990. PMID: 2375598. DOI: 10.1111/j.1749-6632.1990.tb16099.x
• 10. Sporn MB, Roberts AB. Transforming growth factor-beta. Multiple actions and potential clinical applications. JAMA. 1989;262(7):938-941. doi:10.1001/jama.262.7.938
• 11. Lin EY, Pollard JW. Role of infiltrated leucocytes in tumour growth and spread. Br J Cancer. 2004;90(11):2053-2058. doi:10.1038/sj.bjc.6601705
• 12. Xiong S, Dong L, Cheng L. Neutrophils in cancer carcinogenesis and metastasis. J Hematol Oncol. 2021;14(1):173. Published 2021 Oct 21. doi:10.1186/s13045-021-01187-y
• 13. Liu Z, Wang Y, Luo X, Wang Y, Zhang L, Wang T. Prevalence of programmed death-1 ligand-1 (PD-L1) and infiltrating lymphocytes in human gastric carcinogenesis. Int J Clin Exp Pathol. 2017;10(12):11754-11759. Published 2017 Dec 1.
• 14. Zhu H, Cao X. NLR members in inflammation-associated carcinogenesis. Cell Mol Immunol. 2017;14(5):403-405. doi:10.1038/cmi.2017.14
• 15. Zhang Y, Jiang C, Li J, Sun J, Qu X. Prognostic significance of preoperative neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in patients with gallbladder carcinoma. Clin Transl Oncol. 2015;17(10):810-818. doi:10.1007/s12094-015-1310-2
• 16. Koh CH, Bhoo-Pathy N, Ng KL, et al. Utility of pre-treatment neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as prognostic factors in breast cancer. Br J Cancer. 2015;113(1):150-158. doi:10.1038/bjc.2015.183
• 17. Morkavuk ŞB, Kocaöz S, Korukluoğlu B. Diagnostic value of Platelet/lymphocyte Ratio (PLR) for predicting sentinel axillary lymph node positivity in early-stage breast cancer compared with ultrasonography. Int J Clin Pract. 2021;75(12):e14939. doi:10.1111/ijcp.14939
• 18. Rusthoven CG, Rabinovitch RA, Jones BL, et al. The impact of postmastectomy and regional nodal radiation after neoadjuvant chemotherapy for clinically lymph node-positive breast cancer: a National Cancer Database (NCDB) analysis. Ann Oncol. 2016;27(5):818-827. doi:10.1093/annonc/mdw046
• 19. Morrow M, Khan AJ. Locoregional Management After Neoadjuvant Chemotherapy. J Clin Oncol. 2020;38(20):2281-2289. doi:10.1200/JCO.19.02576
• 20. Galimberti V, Ribeiro Fontana SK, Maisonneuve P, et al. Sentinel node biopsy after neoadjuvant treatment in breast cancer: Five-year follow-up of patients with clinically node-negative or node-positive disease before treatment. Eur J Surg Oncol. 2016;42(3):361-368. doi:10.1016/j.ejso.2015.11.019
• 21. Boileau JF, Poirier B, Basik M, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J Clin Oncol. 2015;33(3):258-264. doi:10.1200/JCO.2014.55.7827
• 22. Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455-1461. doi:10.1001/jama.2013.278932
• 23. Classe JM, Loaec C, Gimbergues P, et al. Sentinel lymph node biopsy without axillary lymphadenectomy after neoadjuvant chemotherapy is accurate and safe for selected patients: the GANEA 2 study. Breast Cancer Res Treat. 2019;173(2):343-352. doi:10.1007/s10549-018-5004-7
• 24. Kuehn T, Bauerfeind I, Fehm T, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol. 2013;14(7):609-618. doi:10.1016/S1470-2045(13)70166-9
• 25. Caudle AS, Bedrosian I, Milton DR, et al. Use of Sentinel Lymph Node Dissection After Neoadjuvant Chemotherapy in Patients with Node-Positive Breast Cancer at Diagnosis: Practice Patterns of American Society of Breast Surgeons Members. Ann Surg Oncol. 2017;24(10):2925-2934. doi:10.1245/s10434-017-5958-4
• 26. Cavalcante FP, Millen EC, Zerwes FP, Novita GG. Role of Axillary Surgery After Neoadjuvant Chemotherapy. JCO Glob Oncol. 2020;6:238-241. doi:10.1200/JGO.19.00351
• 27. Giuliano AE, Ballman KV, McCall L, et al. Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial. JAMA. 2017;318(10):918-926. doi:10.1001/jama.2017.11470
• 28. Galimberti V, Cole BF, Viale G, et al. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised, controlled phase 3 trial. Lancet Oncol. 2018;19(10):1385-1393. doi:10.1016/S1470-2045(18)30380-2
• 29. Yang X, Ma X, Yang W, Shui R. Clinical significance of extranodal extension in sentinel lymph node positive breast cancer. Sci Rep. 2020;10(1):14684. Published 2020 Sep 7. doi:10.1038/s41598-020-71594-7