NLR, PLR, SII, ABI For Predicting Non-sentinel Lymph Node Metastasis In Breast Cancer

Background:The standard operation model for axillary lymph nodes has transformed from axillary lymph nodes dissection to sentinel lymph node biopsy.The patients with sentinel lymph node positive still have 40%-60% negative metastasis after lymph node dissection,which suggest the patients suffer from unnecessary surgery.In clinical,the risk of non-sentinel lymph node(NSLN)metastasis in patients with positive sentinel lymph nodes(SLN)can be assessed by clinical information and pathological results,which can help patients with low-risk to avoid lymph node dissection or radiotherapy.However,it remains to unclear how to evaluate the possibility of NSLN metastasis.Therefore,it is important to find reliable indexes to assess the metastatic risk of non-sentinel lymph nodes.Inflammation is related to tumor development.Neutrophils,lymphocytes,monocytes,platelets,body mass index,serum albumin and other inflammatory factors mutually effected with each other.By calculating neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),systematic immune inflammation index(SII),and the advanced breast cancer inflammation index(ABI)can obtain stable and repeatable factors.According to these predicable inflammatory factors for metastasis of NSLN,we construct a risk model,which can help the surgeons to avoid lymph node dissection for these patients.Objective:To investigate the factors that influenced non-sentinel lymph node metastasis in early breast cancer patients with positive axillary sentinel lymph node.The study focused on the relationship between node metastasis and clinicopathological feature clinicopathologic feature,NLR,PLR,SII and ABI.A risk prediction model was established to evaluate the power of relevant indicators in predicting the metastasis of NSLN in positive lymph node in breast cancer.Methods:We have collected the data from early stage breast cancer in the second hospital of Jilin university from January 2015 to August 2019 for retrospect analysis,which was diagnosed breast cancer with positive sentinel lymph node,meanwhile those patients must have complete clinical data and pathological specimens.The AUC,sensitivity and specificity were calculated by using the subject operating curve to calculate the cut-off value of inflammatory factors.Chi-square test and multivariate logistic regression analysis were used to analyze the relationship between nonsentinel lymph node metastasis,peripheral blood inflammatory factors and clinicopathological characteristics.Nomogram risk prediction model was built by R language software.Results:A total number of 134 patients were included in this study,68 were non-sentinel lymph node negative and 66 were non-sentinel lymph node positive.According to the ROC curve,the cut-off values of NLR,PLR,SII,ABI was 2.39,132.17,744.80,440.69,respectively.Univariate analysis showed that non-sentinel lymph node metastasis was significantly associated with tumor diameter(p<0.001),number of sentinel lymph nodes(p<0.001),vascular infiltration(p<0.001),NLR(p<0.001),PLR(p=0.001),SII(p<0.001),and ABI(p<0.001)in breast cancer patients with positive sentinel lymph nodes.There was no significance between age(p=0.767),menopausal status(p=0.606),position(p=0.294),pathological type(p=0.695),pathological grade(p=0.948),ER(p=0.602),PR(p=0.737),Her-2(p=0.764)and Ki67(p=0.317)and metastasis in NSLN.Multivariate logistic regression analysis showed that tumor size(OR=2.749,P=0.026),vascular infiltration(OR=4.901,p=0.001),numbers of sentinel lymph node metastasis(OR=8.335,P=0.044),and NLR(OR=1.788,p<0.001)were independent factors for non-sentinel lymph node metastasis.The AUC value of the prediction model was 0.8532,which indicates good predictive ability and clinical meaning.Conclusion: 1.NLR,PLR,SII,ABI could predict non-sentinel lymphatic metastasis.2.Tumor diameter,numbers of sentinel lymph nodes,vascular infiltration were associated with non-sentinel lymph node metastasis in patients with SLN metastases.3.Tumor size,vascular infiltration,numbers of sentinel lymph node metastases,and NLR could be independent factors to locate high-risk groups that have non-sentinel lymph node metastases.4.The model can predict the risk of non-sentinel lymph node metastasis in patients with positive sentinel lymph node.5.Doctors can consider eliminating ALND on positive sentinel lymph nodes patients with low prediction risk to reduce postoperative complications and surgical burden.