Publication: Pan-İmmün-İnflamasyon Değerinin Neoadjuvan Tedavi Alan Meme Kanseri Hastalarında Kemoterapi Yanıtını Değerlendirmesi
Abstract
Giriş ve Amaç: Meme kanseri dünya çapında en sık teşhis edilen, kadınlarda en çok ölüme neden olan kanserdir. Günümüzde tanı anında değerlendirmeler daha detaylı olduğu için,bu değerlendirmeler sonrasında farklı tedavi yöntemleri tercih edilmektedir. Sistemik inflamasyonun kanser gelişiminde önemli bir risk faktörü olduğu biliniyor. Vücuttaki inflamatuar tepkideki bozukluklar kanserin gelişimi ve progresyonu açısından yatkınlık yaratabilir. Kronik inflamasyonun bazı kanser türleri ile ilişkili olduğu gösterilmiştir. Periferik kan hücresi elemanlarının bağışıklık sistemi hakkında bilgi sağlayabileceğine dayanarak nötrofil/lenfosit,monosit/lenfosit, trombosit/lenfosit gibi oranlara bakılarak bunların prognostik değere sahip olduğu gösterilmiş. Son zamanda nötrofil/lenfosit oranı ve trombosit/lenfosit oranı ile ilgili çalışmalar yapıldı ve bu skorlamaların yüksek olması kötü prognoz ile ilişkilendirildi. Ancak bu indeksler sadece iki immün inflamatuar hücre sayısını değerlendirmektedir. Bu çalışmada lenfositlere ek olarak nötrofil, trombosit ve monosit düzeyini de içeren PIV (Pan immün inflamasyon değeri) skorunu araştırmamız da kullanıldı. Meme kanseri nedeniyle neoadjuvan tedavi alan ve sonrasında ameliyat olan hastaların kemoterapi yanıtını PIV skoru ile patolojik yanıtı değerlendiren Miller Payne değerini kullanarak, bu skorlamanın etkinliğini ve merkezimizdeki sonuçlarını ortaya konması amaçlandı. Gereç ve Yöntem: Kliniğimizde aynı ekip tarafından Ocak 2019- Ocak 2024 tarihleri arasında meme kanseri nedeniyle neoadjuvan tedavi alan ve sonrasında ameliyat olan hastalar tarandı. Yaş, BMİ, menapoz öyküsü, ailede meme kanseri öyküsü gibi demografik veriler, tümörün patolojik tanısı, evresi, hormon reseptör durumu, tümör boyutu, neoadjuvan tedavi öncesi kan değerleri (Nötrofil, Lenfosit, Trombosit, Monosit sayısı), neoadjuvan tedaviye yanıtlarını değerlendirildi. Verilerin normal dağılıma uygunluğunun test edilmesinde Kolmogorov-Smirnov sınaması, iki kategorili bağımsız grupların ortalama karşılaştırmasında Mann-Whitney U testi, ikiden çok kategorili bağımsız grupların ortalama karşılaştırmasında Kruskal Wallis testi, kategorik değişkenlerin bağımsızlık sınaması için Ki-kare bağımsızlık testi, bağımlı ve bağımsız değişkenler arasındaki ilişkilerin incelenmesinde Lojistik Regresyon Analizi kullanıldı. 13 Bulgular: Çalışmaya dahil edilen hastalarda Miller Payne seviyesi yüksek olan grubun PIV skor ortancası 245,8 düşük olan grubun ortancası 266,2 şeklinde sonuçlandı. PCR 'hayır' grubundakilerin PIV skor ortancası (266.2), 'evet' grubundakilerin PIV skor ortancasından (245.8) büyük olmasına rağmen anlamlı sonuca ulaşılamadı. Sonuç: Pan-İmmün-İnflamasyon skorunun patolojik yanıtla ilişkisi olduğu gösterildi. Ancak istatiksel olarak anlamlı bir sonuca ulaşılamadı. Meme kanseri tanısı alan ve neoadjuvan tedavi gereksinimi olan hastaların seçiminde dikkate alınabilmesi için daha çok merkezli çalışmalara ihtiyaç vardır. Anahtar Kelimeler:Meme kanseri, Pan-İmmün-İnflamasyon skoru, Patolojik yanıt, Neoadjuvan tedavi
Introduction and Aim: Breast cancer is the most commonly diagnosed cancer worldwide and the leading cause of death in women. Nowadays, with more detailed evaluations at the time of diagnosis, different treatment methods are preferred after these evaluations. We know that systemic inflammation is an important risk factor in cancer development. Ratios such as neutrophil/lymphocyte, monocyte/lymphocyte, platelet/lymphocyte have been shown to have prognostic value based on the idea that peripheral blood cell elements can provide information about the immune system. Disturbances in the inflammatory response in the body can create susceptibility in terms of cancer development and progression. Chronic inflammation has been shown to be associated with some types of cancer. Tumor cells can manipulate the body's immune responses. Recently, studies have been conducted on Neutrophil/Lymphocyte ratio and Platelet/Lymphocyte ratio, and high scores in these evaluations have been associated with poor prognosis. However, these indexes evaluate only the numbers of two immune inflammatory cells. Therefore, we used the PIV score, which includes the levels of neutrophils, platelets, and monocytes in addition to lymphocytes, in our research. We aimed to demonstrate the effectiveness of this scoring system and our center's results by evaluating the chemotherapy response and pathological response using the PIV score and the Miller Payne score in patients who received neoadjuvant therapy for breast cancer and underwent surgery thereafter. Materials and Methods: In this study, patients who received neoadjuvant therapy for breast cancer and underwent surgery by the same team at our clinic between January 2019 and January 2024 were screened. Demographic data such as age, BMI, menopausal history, family history of breast cancer, pathological diagnosis of the tumor, stage, hormone receptor status, tumor size, pre-neoadjuvant treatment blood values (Neutrophil, Lymphocyte, Platelet, Monocyte counts), and responses to neoadjuvant treatment were evaluated. Kolmogorov-Smirnov test was used to test the normal distribution of the data, Mann-Whitney U test for comparing means of two categorical independent groups, Kruskal Wallis test for comparing means of more than two categorical independent groups, Chi-Square independence test for testing 15 the independence of categorical variables, and Logistic Regression Analysis for examining relationships between dependent and independent variables. Results: In the patients included in the study, the PIV score range for the group with low Miller Payne level was 24-115 with a median of 256.50, and for the group with high Miller Payne level, the score range was 143-1483 with a median of 362.5. There was a statistically significant difference in the mean PIV scores between the Miller Payne groups (p<0.05). The PIV score of the group with high Miller Payne level was significantly higher than that of the low group. Conclusion: In the group with high Miller Payne level among the included patients, the median of PIV score was 245.8, while in the group with low Miller Payne level, it was 266.2. Although the median PIV score of the 'no' group in terms of PCR (266.2) was higher than the median PIV score of the 'yes' group (245.8), a significant conclusion could not be reached. Keywords: Breast cancer, Pan-Immun-Inflammation score, Pathological response, Neoadjuvant treatment
Introduction and Aim: Breast cancer is the most commonly diagnosed cancer worldwide and the leading cause of death in women. Nowadays, with more detailed evaluations at the time of diagnosis, different treatment methods are preferred after these evaluations. We know that systemic inflammation is an important risk factor in cancer development. Ratios such as neutrophil/lymphocyte, monocyte/lymphocyte, platelet/lymphocyte have been shown to have prognostic value based on the idea that peripheral blood cell elements can provide information about the immune system. Disturbances in the inflammatory response in the body can create susceptibility in terms of cancer development and progression. Chronic inflammation has been shown to be associated with some types of cancer. Tumor cells can manipulate the body's immune responses. Recently, studies have been conducted on Neutrophil/Lymphocyte ratio and Platelet/Lymphocyte ratio, and high scores in these evaluations have been associated with poor prognosis. However, these indexes evaluate only the numbers of two immune inflammatory cells. Therefore, we used the PIV score, which includes the levels of neutrophils, platelets, and monocytes in addition to lymphocytes, in our research. We aimed to demonstrate the effectiveness of this scoring system and our center's results by evaluating the chemotherapy response and pathological response using the PIV score and the Miller Payne score in patients who received neoadjuvant therapy for breast cancer and underwent surgery thereafter. Materials and Methods: In this study, patients who received neoadjuvant therapy for breast cancer and underwent surgery by the same team at our clinic between January 2019 and January 2024 were screened. Demographic data such as age, BMI, menopausal history, family history of breast cancer, pathological diagnosis of the tumor, stage, hormone receptor status, tumor size, pre-neoadjuvant treatment blood values (Neutrophil, Lymphocyte, Platelet, Monocyte counts), and responses to neoadjuvant treatment were evaluated. Kolmogorov-Smirnov test was used to test the normal distribution of the data, Mann-Whitney U test for comparing means of two categorical independent groups, Kruskal Wallis test for comparing means of more than two categorical independent groups, Chi-Square independence test for testing 15 the independence of categorical variables, and Logistic Regression Analysis for examining relationships between dependent and independent variables. Results: In the patients included in the study, the PIV score range for the group with low Miller Payne level was 24-115 with a median of 256.50, and for the group with high Miller Payne level, the score range was 143-1483 with a median of 362.5. There was a statistically significant difference in the mean PIV scores between the Miller Payne groups (p<0.05). The PIV score of the group with high Miller Payne level was significantly higher than that of the low group. Conclusion: In the group with high Miller Payne level among the included patients, the median of PIV score was 245.8, while in the group with low Miller Payne level, it was 266.2. Although the median PIV score of the 'no' group in terms of PCR (266.2) was higher than the median PIV score of the 'yes' group (245.8), a significant conclusion could not be reached. Keywords: Breast cancer, Pan-Immun-Inflammation score, Pathological response, Neoadjuvant treatment
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