Predictive Value Of Hematological Markers Of Systemic Inflammation For Efficacy Of Neoadjuvant Chemotherapy In Breast Cancer

Background:Neoadjuvant chemotherapy(NAC)is the systemic therapy before surgery.The main objective of NAC is downsizing of the tumor in order to enhance the rate of breast conserving surgery.Nowadays,NAC has become a common treatment in China because most of patients were locally advanced breast cancer.The estimated response rate of NAC is 60-90%and the pathological complete response(pCR)rate can reach 20%.However,it is inevitable that part of the patients may progress during the NAC.Furthermore,patients who can not achieve pCR may lose the opportunity of early surgery which may increase financial burden.We hope that we can find more convenience and effective biomarker to predict the therapeutic response of breast cancer.Objective:The purpose of our study was to evaluate the predictive value of the preoperative LMR,MRR,RDW,PC and PLR for efficacy of neoadjuvant chemotherapy in breast cancer.To provide clinical evidence for new predictive models.Methoed:A total of 180 female patients from Nanfang Hospital between 2011 and 2017 were enroll in our retrospective study.Lymphocyte count,monocyte count,red blood cell count,RDW and platelet count were collected.Collecting the image data before and after the NAC and used the RECIST criteria to evaluate the therapeutic effect.The cases were divided into two groups by the optimal cutoff based on receiver operating characteristic.Then analysed the relationship between different group and the response of NAC.Multivariate was used to explore the independent factors of efficacy.Besides,we further analysed the value of this five markers in predicting efficacy of NAC in different subgroup.Result:1.The low-MRR group had significantly more patients>45 years old and the high-PC group had more PR positive,Her-2 negative and premenopausal patients.High-PLR group also had more premenopausal patients than low-PLR group.2.MRR.PLR and PC were related to the response of NAC(P<0.05),while LMR only correlated with the response rate in PR positive patient and patient with low BMI(BMI?24).3.MRR(OR:1.732,95%CI:1.020-3.261,P=0.049)and PLR(OR:0.419,95%CI:0.217-0.807,P=0.027)were independent predictors to efficacy of NAC in breast cancer.4.In subgroup analyses,MRR show independent predictive value in remission rate of NAC in patient with lymph node involvement,higher clinical stage,negative ER status and negative PR status.Meanwhile,PLR was the independent predictor in patient younger than 45 years old,lower BMI(BMI?24).with larger tumor size(>5cm),negative lymph node status,higher clinical stage,negative ER status,negative PR status,negative Her-2 status and with invasive ductal carcinoma.We also find lower PC independently indicate higher response to NAC in patient younger than 45 years old.Conclusions:1.MRR,PLR and PC were related to the response of NAC in breast cancer and LMR showed predictive value in patient with lower BMI and positive PR status.2.MRR and PLR could serve as an independent predictors to NAC in breast cancer patient.The pretherapy value of MRR and PLR can assist clinicians to forecast the efficacy of NAC and make therapeutic strategy.3.Our study conducted further stratification analysis of breast cancer patients and provided new predictors for patients with different clinical and pathology characteristic.We believed this would help to establish new predictive model.