Nomogram Based on the Dynamic Change in the Neutrophil-to-Lymphocyte Ratio for Predicting the Pathological Complete Response of Breast Cancer after Neoadjuvant Systemic Therapy.

IF 1.6 4区 医学 Q3 ONCOLOGY
Yichun Gong, Lexin Wang, Hong Yin, Mingyu Wang, Wenjie Shi, Jue Wang, Lu Xu, Xiaoming Zha
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引用次数: 0

Abstract

Introduction: This study aimed to investigate the predictive effect of peripheral blood inflammatory indexes on total pathologic complete response (tpCR) in patients with breast cancer receiving neoadjuvant systemic therapy (NST).

Methods: We identified significant prognostic factors for tpCR in the training cohort using univariate and multivariate logistic analysis to build a nomogram based on multicenter data. The performance of the model underwent 1,000-bootstrap resample internal validation and external validation. The area under the receiver operating characteristic (AUC) curve and the calibration curve were used to measure predictive accuracy and discriminative ability. This study was conducted under the Declaration of Helsinki and the approval and supervision of the Ethics Review Committee (2020-SR-053) retrospectively registered.

Results: This retrospective study included 353 patients with breast cancer receiving NST, including 244 and 109 patients in the training and the external validation cohort. Multivariate logistic regression analysis revealed ER status, PR status, HER2 status, T stage, baseline lymphocyte, and percentage change in neutrophil-to-lymphocyte ratio (NLR, an immune system status-associated indicator) as independent predictors of tpCR. Baseline NLR in the tpCR group was significantly lower than that in the non-tpCR group, but percentage change in the NLR was significantly higher in the tpCR group, exhibiting opposite predictive trends. A nomogram was developed based on these results. The AUC curve of the training cohort, bootstrap resampling internal validation, and external validation cohort were 0.832, 0.806, and 0.814, respectively. The calibration curve for the probability of tpCR revealed optimal agreement between the probability and the actual probability. The subgroup analysis revealed that baseline NLR was significantly correlated with tpCR in patients with HER2 overexpression and luminal breast cancer.

Conclusion: A nomogram based on the dynamic change in the NLR was developed, thereby helping adjusting treatment plans because NST may change the functional phenotype of some inflammatory cells and affect tumor microenvironment.

基于中性粒细胞与淋巴细胞比值动态变化的Nomogram预测乳腺癌新辅助全身治疗后病理完全缓解。
目的:探讨外周血炎症指标对乳腺癌新辅助全身治疗(NST)患者总病理完全缓解(tpCR)的预测作用。方法:我们通过单因素和多因素logistic分析确定训练队列中tpCR的重要预后因素,建立基于多中心数据的nomogram。模型的性能经过了1000个bootstrap样本的内部验证和外部验证。用受试者工作特性曲线下面积和校准曲线来衡量预测精度和判别能力。本研究是根据赫尔辛基宣言进行的,并在回顾性注册的伦理审查委员会(2020-SR-053)的批准和监督下进行的。结果:本回顾性研究纳入353例接受NST治疗的乳腺癌患者,其中培训组244例,外部验证组109例。多因素logistic回归分析显示,ER状态、PR状态、HER2状态、T分期、基线淋巴细胞和中性粒细胞与淋巴细胞比值(NLR,一种免疫系统状态相关指标)变化百分比是tpCR的独立预测因子。tpCR组的基线NLR明显低于非tpCR组,但tpCR组NLR的百分比变化明显高于非tpCR组,表现出相反的预测趋势。在这些结果的基础上,形成了一个图。训练队列、bootstrap重抽样内部验证和外部验证队列的AUC曲线分别为0.832、0.806和0.814。tpCR概率的标定曲线显示了概率与实际概率的最佳一致性。亚组分析显示,HER2过表达和腔内乳腺癌患者的基线NLR与tpCR显著相关。结论:基于NLR动态变化的nomogram,可以帮助调整治疗方案,因为NST可能改变一些炎症细胞的功能表型,影响肿瘤微环境。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.20
自引率
0.00%
发文量
84
期刊介绍: With the first issue in 2014, the journal ''Onkologie'' has changed its title to ''Oncology Research and Treatment''. By this change, publisher and editor set the scene for the further development of this interdisciplinary journal. The English title makes it clear that the articles are published in English – a logical step for the journal, which is listed in all relevant international databases. For excellent manuscripts, a ''Fast Track'' was introduced: The review is carried out within 2 weeks; after acceptance the papers are published online within 14 days and immediately released as ''Editor’s Choice'' to provide the authors with maximum visibility of their results. Interesting case reports are published in the section ''Novel Insights from Clinical Practice'' which clearly highlights the scientific advances which the report presents.
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