Abstract:

Objective　To analyze the value of peripheral blood neutrophil to lymphocyte ratio (NLR) combined with CD8⁺ T lymphocytes in predicting the recurrence of breast cancer patients after breast-conserving surgery. Methods　A total of 106 patients with breast cancer who visited Baoji Maternal and Child Health Hospital from February 2016 to February 2019 were selected. They were (45.82±9.57) years old. The mean maximum tumor diameter was (2.37±0.85) cm. All the patients received breast-conserving surgery, and were followed up for 5 years. According to the recurrence situation, the patients were divided into a non-recurrence group and a recurrence group. The levels of peripheral blood CD8⁺, NLR's, and clinical data were compared between the recurrence group and the non-recurrence group. The factors influencing the recurrence of breast cancer after breast conserving surgery were analyzed. The values of peripheral blood CD8⁺, NLR, and their combination in predicting the recurrence of breast cancer after breast conserving surgery were analyzed.t test, χ² test, and Fisher exact probability method were used. The logistic regression model was used to analyzed the influencing factors. Results　After 5 years' follow-up, 3 of the 106 patients were lost to follow-up, and the follow-up rate was 97.17% (103/106). Of which, 12 patients relapsed, and the recurrence rate was 11.65% (12/103); the remaining 91 patients did not relapse, and the recurrence rate was 88.35% (91/103). The level of peripheral blood CD8⁺ in the recurrence group was lower than that in the non-recurrence group [(23.17±3.36)% vs. (29.45±4.23)%]; the peripheral blood NLR in the recurrence group was higher than that in the non-recurrence group [(2.64±0.39) vs. (1.72±0.24)]; there were statistical differences between the two groups (both P<0.05). The proportion of the patients with lymph node metastasis in the recurrence group was higher than that in the non-recurrence group [58.33% (7/12) vs. 24.18% (22/91); P<0.05]; the proportions of the patients taking postoperative full-course radiotherapy and standard chemotherapy in the recurrence group were lower than those in the non-recurrence group [25.00% (3/12) vs. 93.41% (85/91) and 33.33% (3/12) vs. 89.01% (81/91); both P<0.05]. The logistic regression analysis showed that peripheral blood CD8⁺ decrease (OR=0.285, 95%CI 0.125-0.647), peripheral blood NLR increase (OR=4.175, 95%CI 1.835-9.796), lymph node metastasis (OR=5.013, 95%CI 2.204-11.403), and postoperative full-course radiotherapy (OR=0.255, 95%CI 0.112-0.579) were the influential factors for breast cancer recurrence after breast conserving surgery (all P<0.05). The areas under the curves (AUC) of peripheral blood CD8⁺, NLR, and their combination in predicting breast cancer recurrence after breast preservation surgery were 0.799, 0.844, and 0.905, respectively, and the AUC of the combination was higher (P<0.05). Conclusion　Peripheral blood CD8⁺ T lymphocytes and NLR can be used to predict the recurrence of breast cancer patients after breast-conserving surgery, and the combined value is higher.

Key words:

Breast cancer, CD8⁺ , T lymphocytes, Neutrophil to lymphocyte ratio, Breast-conserving surgery, Recurrence, Prediction

摘要：

目的　分析外周血中性粒细胞与淋巴细胞比值（NLR）联合CD8⁺ T淋巴细胞对乳腺癌患者保乳术后复发的预测价值。方法　选择宝鸡市妇幼保健院2016年2月至2019年2月就诊的乳腺癌患者106例，年龄（45.82±9.57）岁，肿瘤最大径（2.37±0.85）cm，所有患者均接受保乳手术治疗。术后随访5年，根据复发情况分为复发组与非复发组。对比复发组与非复发组外周血CD8⁺、NLR水平及临床资料，分析乳腺癌保乳术后复发的影响因素，外周血CD8⁺、NLR水平及二者联合对乳腺癌保乳术后复发的预测价值。采用t检验、χ²检验、Fisher确切概率法，影响因素分析采用logistic回归模型。结果　随访5年，106例患者中失访3例，随访率为97.17%（103/106），复发12例，复发率为11.65%（12/103），未复发91例（88.35%，91/103）。复发组外周血CD8⁺水平低于非复发组［（23.17±3.36）%比（29.45±4.23）%］，复发组外周血NLR水平高于非复发组［（2.64±0.39）比（1.72±0.24）］，两组比较差异均有统计学意义（均P<0.05）。复发组淋巴结转移例数占比高于非复发组［58.33%（7/12）比24.18%（22/91）］，复发组术后足程放疗、术后规范化疗例数占比低于非复发组［25.00%（3/12）比93.41%（85/91）、33.33%（3/12）比89.01%（81/91）］，两组比较差异均有统计学意义（均P<0.05）。logistic回归分析结果显示，外周血CD8⁺降低（OR=0.285，95%CI 0.125～0.647）、外周血NLR升高（OR=4.175，95%CI 1.835～9.796）、淋巴结转移（OR=5.013，95%CI 2.204～11.403）、术后无足程放疗（OR=0.255，95%CI 0.112～0.579）为乳腺癌保乳术后复发的影响因素（均P<0.05）。外周血CD8⁺、NLR水平及二者联合预测乳腺癌保乳术后复发的曲线下面积（AUC）分别为0.799、0.844、0.905，二者联合的AUC更高（P<0.05）。结论　外周血CD8⁺ T淋巴细胞、NLR可用于预测乳腺癌患者保乳术后复发，且二者联合的预测价值更高。

关键词:

乳腺癌, CD8⁺ , T淋巴细胞, 中性粒细胞与淋巴细胞比值, 保乳手术, 复发, 预测