Correlation Between Preoperative Peripheral Blood Platelet To Lymphocyte Ratio And Clinicopathological Features And Prognosis Of Breast Cancer

Objective:Breast cancer is the most common malignant tumor in women.Effective assessment of its prognosis can help clinicians develop treatment options that are more beneficial to patient survival.However,the current indicators for predicting tumor prognosis are usually derived from imaging examination and postoperative pathological examination.There is a lack of simple and effective indicators for early assessment of prognosis.Inflammation and immunity are involved in the occurrence and development of tumors.Relevant inflammation and immune indicators are also widely used in tumor prognosis research.Platelet-lymphocyte ratio(PLR)can reflect the relative changes of inflammation and immunity in the body.It can be obtained by routine blood tests.This study hopes to retrospectively analyze the case data of some breast cancer patients in our hospital,and to explore the value of preoperative peripheral blood PLR in the early prediction of breast cancer prognosis.Methods:This study will retrospectively analyze the clinical and pathologi-cal data of some patients who were diagnosed with breast cancer by the Department of Pathology of the former Shenyang Military Region General Hospital from January 2013 to March 2015,and who underwent modified radical mastectomy for general surgery.General patient data(age,menopausal status),preoperative laboratory tests(platelet count PLT,lymphocyte count LYM,),preoperative ultrasound BI-RADS classification,postoperative pathology data(tumor size,lymph node metastasis,TNM staging),pathological type,histopathological grade)and immunohistochemical detection indicators(Estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor(HER-2)gene,Ki67,P53,E-Cad).Refer to the“Guidelines and Specifications for Diagnosis and Treatment of Breast Cancer of China Anti-cancer Association” CBCS(2017 Edition)for molecular typing.Postoperative tumor recurrence and metastasis and 3-year survival rate are obtained by telephone or outpatient follow-up.First,X2 test is used to analyze the relationship between PLR and clinical and pathological features of breast cancer,Kruskal-wallis test is used to compare the difference in PLR level between different TNM stages and molecular typing.The survival analysis was conducted by Kaplan-Meier method to explore the correlation between PLR level and 3-year disease-free survival rate and overall survival rate after breast cancer surgery.Finally all clinical and pathological indicators were included in univariate COX regression analysis,Based on the results of univariate analysis,indicators that may affect the prognosis of breast cancer were put into multivariate COX regression analysis to obtain whether preoperative peripheral blood PLR level is an independent influencing factor for poor prognosis after breast cancer surgery,then judge whether it can be a reliable predictor of breast cancer prognosis and provide further research directions for individualized precision treatment of breast cancer.Results:The clinical data of 294 patients were included in this study.The patients were divided into high and low PLR groups with 147 cases in each group by the median value 113.96 of PLR.The Chi-square test showed that the preoperative PLR level is negatively correlated with the menopausal status of breast cancer patients(P=0.006),which means that preoperative peripheral blood PLR level of premenopausal breast cancer patients is usually higher than that of postmenopausal patients.Preoperative PLR was positively correlated with tumor size(P=0.030)and TNM stage(P=0.026),the higher PLR value before operation,the later the tumor stage may be.The Kruskal-Wallis test showed that the PLR level in patients with T1 was significantly lower than that in T2 and T3(P=0.022),but there was no difference between T2 and T3(P=0.642).In TNM stage,there were a same phenomenon that patients were with lower PLR in Phase I than Phase II and III(P=0.019),while there was no significant difference between Phase II and III(P=0.390).The results also showed that high PLR was related to the positive expression of human epidermal growth factor HER-2 gene(P=0.016),but PLR was not associated with other immunohistochemical indexes(P>0.05),such as ER(P=0.500),PR(P=0.320),Ki67(P=0.391),P53(P=0.309),E-cad(P=0.449),etc,and the correlation between PLR and molecular typing is not obvious(P=0.053).Further comparison of PLR levels between different molecular types showed that the PLR level of HER2 positive breast cancer was higher than other molecular subtypes(P=0.028).In addition,PLR level had no correlation with age(P=0.326),pathological type(P=0.570),histological grade(P=0.809),lymph node metastasis(P=0.206).Kaplan-Meier survival analysis showed that the disease-free survival rate of patients with high PLR(PLR≥113.96)was lower than that of patients with low PLR(PLR<113.96)(P=0.012),however,there was no significant difference in overall survival rate of the two groups(P=0.061).Univariate COX regression analysis showed that preoperative PLR(P=0.014),tumor size(P=0.007),lymph node metastasis(P<0.001),TNM staging(P=0.006),estrogen receptor ER(P=0.016),molecular typing(P=0.024)was the influencing factor of disease-free survival in breast cancer patients.The possible factors were included in multivariate analysis and the result showed preoperative PLR(P=0.002),preoperative ultrasound BI-RADS classification(P=0.013),lymph node metastasis(P<0.000)and molecular typing(P=0.004)were independent influencing factors for disease-free survival rate in breast cancer patients.Conclusion:Preoperative high PLR in patients with breast cancer predicts later tumor stage,worse prognosis of molecular classification,and higher metastasis rate and mortality.Preoperative high PLR is an independent influencing factor for disease-free survival after breast cancer surgery,and it can be an early predictor of poor prognosis in breast cancer.