Kocaeli Med J. 2023; 12(2): 276-281 | DOI: 10.5505/ktd.2023.32855

The Role of C-Reactive Protein/Albumin Ratio (CAR), Neutrophil-Lymphocyte Ratio (NLR), and Prognostic Nutritional Index (PNI) in Predicting Treatment Response in Triple Negative Breast Cancer Receiving Neoadjuvant Chemotherapy

Elif Þahin
Department of Medical Oncology, Kocaeli City Hospital, Kocaeli, Turkey

INTRODUCTION: The aim of this study was to investigate the predictive importance of neutrophil-lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR), and prognostic nutritional index (PNI) on treatment response in triple-negative breast cancer (TNBC) patients receiving neoadjuvant chemotherapy (NACT).
METHODS: Data of TNBC patients treated with standard NACT protocol were analyzed retrospectively. ROC-curve analyzes were used for cutt-off determination. Binary logistic regression analysis was used for predictive markers.
RESULTS: 55 patients were included in the study. The cut-off value, which was thought to be ideal for CAR, was 9.86 [sensitivity: 66.7%, specificity: 71.4%, AUC=0.696 (95% CI 0.556-0.836, p=0.013). ROC analysis for NLR and PNI was not statistically significant. Patients with a CAR above 9.86 had an approximately 3.1-fold greater pathological complete response (PCR) than patients with a CAR below 9.86 (OR: 3.167 95% CI: 1.039-9.654, p=0.043). NLR and PNI were not predictive markers for PCR. (OR: 1.096, 95% CI: 0.941-1.276, p=0.23, and OR: 0.981, 95% CI: 0.91-1.057, p=0.610, respectively). Age (OR: 1.023 95% CI: 0.969-1.079, p=0.411), body mass index (1.074 95% CI: 0.938-1.229, p=0.304) and clinical T-stage (OR: 1.014 95% CI: 0.43- 2.394, p=0.975) did not predict PCR. When the results were evaluated with multivariate analysis, it was observed that only ki-67 retained its predictive significance (OR: 1.046, 95% CI: 1.015-1.079, p=0.004). CAR was not significantly predictive against ki-67 (p=0.263).
DISCUSSION AND CONCLUSION: In this study, it was concluded that CAR may be a predictive marker for neoadjuvant chemotherapy response in triple negative breast cancer patients, but it is a weaker marker when evaluated together with ki-67.

Keywords: neutrophil-lymphocyte ratio, c-reactive protein/albumin ratio, triple negative breast cancer, pathological response, immune system, biomarker

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Neoadjuvan Kemoterapi Alan Üçlü Negatif Meme Kanserinde C-Reaktif Protein/Albümin Oraný, Nötrofil-Lenfosit Oraný ve Prognostik Nutrisyonel Ýndeksin Tedavi Yanýtýný Predikte Etmedeki Rolü

Elif Þahin
Kocaeli Þehir Hastanesi, Týbbi Onkoloji, Kocaeli, Türkiye

GÝRÝÞ ve AMAÇ: Bu çalýþmada neoadjuvan kemoterapi alan üçlü negatif meme kanseri hastalarýnda nötrofil-lenfosit oraný (NLR), C-reaktif protein/albümin oraný (CAR) ve prognostik nutrisyonel indeksin (PNÝ) tedavi yanýtý üzerindeki prediktif öneminin araþtýrýlmasý amaçlandý.
YÖNTEM ve GEREÇLER: Standart kemoterapi protokolü ile tedavi edilen, üçlü negatif meme kanseri hastalarýnýn verileri retrospektif olarak incelendi. Cutt-off belirlemede ROC-eðrisi analizleri kullanýldý. Prediktif belirteçler için ikili lojistik regresyon analizinden faydalanýldý. Ýki yönlü testlerde, p deðeri 0.05’in altý istatistiksel olarak anlamlý kabul edildi.
BULGULAR: Çalýþmaya 55 hasta dahil edildi. CAR için ideal olduðu düþünülen kestirim deðeri 9.86 saptandý. Bu kestirim deðeri için sensivite %66.7, spesifite %71.4, AUC=0.696 (%95 güven aralýðýnda 0.556-0.836) idi ( p=0.013 ). NLR ve PNÝ için ROC analizi istatistiksel olarak anlamlý deðildi. CAR 9.86 üzerinde olan hastalar, altýnda olan hastalara göre yaklaþýk olarak 3.1 kat daha fazla patolojik tam yanýta sahipti (OR: 3.167 %95 CI: 1.039-9.654, p=0.043). NLR ve PNÝ tam yanýt için marker özelliði saðlamýyordu (sýrasýyla, OR: 1.096, %95 CI: 0.941-1.276, p=0.23 ve OR: 0.981, %95 CI: 0.91-1.057, p=0.610). Yaþ (OR: 1.023 %95 CI: 0.969-1.079, p=0.411), beden kitle indeksi (1,074 %95 CI: 0.938-1.229, p=0.304) ve klinik T-evresi (OR: 1.014 %95 CI: 0.43-2.394, p=0.975) tam yanýtý predikte etmiyordu. Bulgular çok deðiþkenli analiz ile deðerlendirildiðinde sadece ki-67’nin prediktif önemini koruduðu görüldü (OR: 1.046, %95 CI: 1.015-1.079, p=0.004). CAR ise ki-67 karþýsýnda anlamlý prediktif deðildi (p=0.263).
TARTIÞMA ve SONUÇ: Bu çalýþmada, üçlü negatif meme kanseri hastalarýnda CAR’ýn neoadjuvan kemoterapi yanýtý için prediktif bir belirteç olabileceði, ancak ki-67 ile birlikte deðerlendirildiðinde daha zayýf bir belirteç olduðu sonucuna varýldý.

Anahtar Kelimeler: nötrofil-lenfosit oraný, c-reaktif protein/albumin oraný, üçlü negatif meme kanseri, patolojik yanýt, belirteç, biyomarker

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