Ratios of C-reactive protein,lactate dehydrogenase and alkaline phosphatase to albumin in evaluating neoadjuvant chemotherapy for breast cancer
Objective To observe the differences of C-reactive protein(CRP)to albumin(ALB)ratio(CAR),lactate dehydrogenase(LDH)to ALB ratio(LAR)and alkaline phosphatase(ALP)to ALB ratio(APAR)in breast cancer patients with different responses to neoadjuvant chemotherapy,and to explore the values of CAR,LAR and APAR to the evaluation of efficacy of neoadjuvant chemotherapy on breast cancer.Methods Totally 125 patients with breast cancer were diagnosed and treated in the Second Affiliated Hospital of Zhengzhou University from January 2020 to January 2024.All patients received 6 to 8 cycles of neoadjuvant chemotherapy,and surgery was performed within 3 weeks after the end of neoadjuvant chemotherapy.The serum levels of CRP,ALB,LDH and ALP were detected before the first treatment,and CAR,LAR and APAR were calculated.Based on the imaging examination before neoadjuvant chemotherapy and pathological examination of surgically resected tissues,the efficacy of neoadjuvant chemotherapy(grade 1-5)was determined,by which 125 patients were divided into the sensitive group(grade 3-5)and the insensitive group(grade 1-2).The rates of positive HER-2 and Ki-67≥15％as well as CAR,LAR and APAR were compared between two groups.Multivariate logistic regression was used to analyze the influencing factors of neoadjuvant chemotherapy sensitivity in breast cancer patients.ROC curves were drawn to evaluate the efficiencies of CAR,LAR and APAR on predicting neoadjuvant chemotherapy sensitivity.Results Among these 125 patients,there were 98 in the sensitive group(23 cases of grade 3,34 of grade 4,and 41 of grade 5)and 27 in the insensitive group(9 cases of grade 1,18 of grade 2).The rate of Ki-67 ≥15％,CAR,LAR and APAR were lower in the sensitive group(26.5％,1.56±0.59,3.68±0.71,1.58±0.37)than those in the insensitive group(88.9％,1.80±1.15,4.04±0.74,2.57±0.92)(x2=34.297,t=-7.544,t=-2.130,t=-8.268;all P values＜0.05).HER-2 positive(OR=0.762,95％CI:0.252-2.305,P=0.031),Ki-67(OR=0.033,95％CI:0.008-0.135,P=0.001),CAR(OR=0.333,95％CI:0.129-0.861,P=0.023),LAR(OR=0.470,95％CI:0.188-1.179,P=0.018),and APAR(OR=0.020,95％CI:0.002-0.194,P=0.001)were the influencing factors of neoadjuvant chemotherapy sensitivity in breast cancer patients.With 1.085,4.306 and 1.920 as the optimal cut-off values of CAR,LAR and APAR,the AUCs of them single and in combination for predicting neoadjuvant chemotherapy sensitivity were 0.881(95％CI:0.803-0.959,P=0.016),0.632(95％CI:0.501-0.762,P=0.046),0.922(95％CI:0.860-0.984,P=0.033),and 0.952(95％CI:0.906-0.999,P＜0.001),the sensitivities were 79.2％,81.7％,95.8％and 91.1％,and the specificities were 89.1％,85.1％,83.2％and 91.7％,respectively.Conclusion Neoadjuvant chemotherapy achieves a good efficacy in breast cancer patients with low CAR,LAR and APAR,and the combination of CAR,LAR and APAR has a high predictive value.
breast cancerneoadjuvant chemotherapyC-reactive protein to albumin ratiolactate dehydrogenase to albumin ratioalkaline phosphatase to albumin ratio
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