Razão de neutrófilos/linfócitos periféricos como preditor prognóstico em pacientes com câncer de mama submetidas à quimioterapia neoadjuvante

Abstract

Breast cancer is a public health problem with estimates from the National Cancer Institute of 66,280 new cases per year in Brazil during the 2020-2022 period. Neoadjuvant treatment is administered prior to a definitive local treatment and intends to reduce tumor volume, ideally trying to achieve complete pathological response. Inflammation associated with the tumor may be related to systemic inflammation and may also play an important role in the development of cancer, sensitivity to chemotherapy and survival. To verify the predictive value of a biomarker - neutrophil/lymphocyte ratio - for complete pathological response in patients with breast cancer and submitted to neoadjuvant chemotherapy. This is a historical cohort study of patients diagnosed with breast cancer confirmed by biopsy and candidates for neoadjuvant chemotherapy from January 2014 to December 2019 treated at the Mastology Service of Hospital São Lucas da PUCRS. From these, the number of neutrophils and basal lymphocytes were collected, the ratio between these cell counts was calculated and associations were established. The cut-off point for the neutrophil-to-lymphocyte ratio calculated according to the analysis of the ROC curve was 2.45 and 2 groups (low and high) were established. Of the 54 patients (26%) in the studied sample who obtained complete pathological response after neoadjuvant chemotherapy, 12 of them (17.39%) belonged to the high neutrophil/lymphocyte ratio group (OR 0.45, 95% CI 0.2-0.9, p=0,03), demonstrating that patients with this high baseline ratio were less likely to obtain a complete response after neoadjuvancy. In a period of 60 months, the overall survival and disease free survival of the sample were 84.21% and 71.93%, respectively. The disease free survival curve stratified by complete pathological response, patients with a response had a statistically significant longer survival than those who did not respond to therapy. Although several clinical and pathological factors that are associated with an increased risk of recurrence and / or mortality in patients with breast cancer are clearly known, neutrophil/lymphocyte ratio has proved to be a low-cost and easily accessible prognostic marker, being a possible tool for risk estimates within the stages and subgroups of the disease.