Cemil YÜKSEL, Serdar ÇULCU, Selim TAMAM, Elifcan HABERAL, Bülent AKSEL, Lütfi DOĞAN

Is the Platelet-Lymphocyte Ratıo a Useful Tool for Predicting Sentinel Lymph Node Metastasıs in Breast Cancer Patients Receiving Neoadjuvant Therapy?

Amaç: Meme kanseri kadınlarda morbidite ve mortalitesi en yüksek kanserlerden biridir. Aksiller lenf nodlarının cerrahi olarak çıkarılması, aksiller metastazı olanlarda evrelemeyi kolaylaştırır ve bölgesel kontrol sağlar. Primer cerrahi uygulanan cN0 hastalığı olan hastaların yönetiminde SLNB rutin olarak yapılsa da neoadjuvan kemoterapi alan hastalarda SLNB’ nin ne zaman yapılacağı tartışmalıdır. Çalışmamızda neoadjuvan tedavi alan meme kanserli hastalarda neoadjuvan tedavi öncesi ve sonrası trombosit/lenfosit oranının sentinel lenf nodu metastazlarını öngörmedeki başarısını değerlendirdik. Gereç ve Yöntemler: Kliniğimizde lokal ileri meme kanseri nedeniyle neoadjuvan kemoterapi almış hastalar değerlendirildi. Bu hastalar arasından, aksilla metastazı histopatolojik olarak kanıtlanmış fakat neoadjuvan tedavi sonrası klinik muayenede ve görüntüleme yöntemlerinde patolojik lenf nodu izlenmeyen hastalar değerlendirildi. Bulgular: Sentinel lenf nodu örneklemesi için ortalama 3.81 adet lenf nodu eksizyonu yapıldı. PLR cut-off değerini Roc-curve analiz ile çalıştık. 0.061 standart hata ile cut-off değerini 138.88 bulduk (p=0.001). PLR yüksek olan hastalarda sentinel lenf nodunda metastaz olma olasılığı, PLR düşük olan hastalara göre daha yüksektir (OR= 1.013, 95%Cl: 1.005-1.021, p=0.002). Ayrıca PLR ile metastatik sentinel lenf nodu sayısı arasında da pozitif yönde anlamlı ilişki bulduk (p=0.005). PLR’de her bir birim artışı, metastatik sentinel lenf nodu sayısında 0.004 birim artışa neden olabilmektedir. Sonuç: Neoadjuvan kemoterapi alan hastalarda PLR pratik, basit ve ucuz bir hematolojik gösterge olarak sentinel lenf nodu metastazını tahmin etmede önemli bir rol oynar ve cerrahi öncesi uygun tedavi planı seçimini kolaylaştırabilir.

Anahtar Kelimeler:

Sentinel Lymph Node, breast cancer, inflammatory parameters

Is the Platelet-Lymphocyte Ratıo a Useful Tool for Predicting Sentinel Lymph Node Metastasıs in Breast Cancer Patients Receiving Neoadjuvant Therapy?

Aim: Breast cancer is one of the cancers with the highest morbidity and mortality in women. Surgical excision of axillary lymph nodes facilitates staging and provides regional control in those with axillary metastases. Although SLNB is routinely performed in the management of patients with cN0 disease who underwent primary surgery, it is controversial when to perform SLNB in patients receiving neoadjuvant chemotherapy. In our study, we evaluated the success of the platelet/lymphocyte ratio before and after neoadjuvant therapy in predicting sentinel lymph node metastases in breast cancer patients receiving neoadjuvant therapy. Materials-Methods: Patients who received neoadjuvant chemotherapy for locally advanced breast cancer in our clinic were evaluated. Among these patients, patients with histopathologically proven axilla metastases but no pathological lymph nodes in clinical examination and imaging methods after neoadjuvant therapy were evaluated. Results: An average of 3.81 lymph node excisions were performed for sentinel lymph node sampling. We studied the PLR cut-off value with Roc-curve analysis. We found the cut-off value of 138.88 with a standard error of 0.061 (p=0.001). Patients with high PLR are more likely to have sentinel lymph node metastases than patients with low PLR (OR= 1.013, 95%Cl: 1.005-1.021, p=0.002). We also found a significant positive correlation between PLR and the number of metastatic sentinel lymph nodes (p=0.005). Each unit increase in PLR can cause an increase of 0.004 units in the number of metastatic sentinel lymph nodes. Conclusion: In patients receiving neoadjuvant chemotherapy, PLR plays an important role in predicting sentinel lymph node metastasis as a practical, simple, and inexpensive hematological indicator and may facilitate the selection of an appropriate treatment plan before surgery. Keywords: Sentinel lymph node, Breast cancer, inflammatory parameters

Keywords:

Sentinel lymph node, Breast cancer, inflammatory parameters,

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