Dooreh Kim1, Soong June Bae2,3, Sung Gwe Ahn2,3, Joon Jeong2,3, Seho Park4, Woo-Chan Park1, Goeun Park5, Sujee Lee5, Chang Ik Yoon6. 1. Division of Breast Surgery, Department of Surgery, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea. 2. Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 3. Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. 4. Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 5. Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea. 6. Division of Breast Surgery, Department of Surgery, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea. fayn03@gmail.com.
Abstract
PURPOSE: Radiation-induced anti-tumor responses occur in the immune system, particularly in peripheral blood mononuclear cells (PBMCs), which are overly sensitive to ionizing radiation. Irradiation of PBMCs is associated with inflammation. We assessed the association between radiotherapy (RT)-induced changes in peripheral blood cells, utilizing the lymphocyte-to-monocyte ratio (LMR), and survival outcome in breast cancer patients who underwent breast-conserving surgery followed by adjuvant RT. METHODS: LMR values were obtained from retrospective data, and serial sampling of blood before the first and last RT sessions was performed. The cut-off point was analyzed using the Youden index and receiver operating characteristic curve. Recurrence-free survival (RFS) and overall survival (OS) were the main outcomes. RESULTS: Patients with RT-induced low LMR had significantly shorter RFS (hazard ratio [HR] 2.730; 95% confidence interval [CI], 1.607-4.636, P = 0.0002) and OS (HR 2.890; 95% CI 1.410-5.924, P = 0.0038). The results were more robust in the subgroup of patients who received chemotherapy. Multivariate analysis showed that lymph node metastasis and RT-induced low LMR were associated with poor RFS (HR 1.763; 95% CI, 1.017-3.059, P = 0.044) and OS (HR 2.254; 95% CI, 1.060-4.796, P = 0.035). CONCLUSION: This study demonstrates that RT-induced low LMR is a valid prognostic marker for recurrence and survival in breast cancer patients undergoing RT.
PURPOSE: Radiation-induced anti-tumor responses occur in the immune system, particularly in peripheral blood mononuclear cells (PBMCs), which are overly sensitive to ionizing radiation. Irradiation of PBMCs is associated with inflammation. We assessed the association between radiotherapy (RT)-induced changes in peripheral blood cells, utilizing the lymphocyte-to-monocyte ratio (LMR), and survival outcome in breast cancer patients who underwent breast-conserving surgery followed by adjuvant RT. METHODS: LMR values were obtained from retrospective data, and serial sampling of blood before the first and last RT sessions was performed. The cut-off point was analyzed using the Youden index and receiver operating characteristic curve. Recurrence-free survival (RFS) and overall survival (OS) were the main outcomes. RESULTS: Patients with RT-induced low LMR had significantly shorter RFS (hazard ratio [HR] 2.730; 95% confidence interval [CI], 1.607-4.636, P = 0.0002) and OS (HR 2.890; 95% CI 1.410-5.924, P = 0.0038). The results were more robust in the subgroup of patients who received chemotherapy. Multivariate analysis showed that lymph node metastasis and RT-induced low LMR were associated with poor RFS (HR 1.763; 95% CI, 1.017-3.059, P = 0.044) and OS (HR 2.254; 95% CI, 1.060-4.796, P = 0.035). CONCLUSION: This study demonstrates that RT-induced low LMR is a valid prognostic marker for recurrence and survival in breast cancer patients undergoing RT.
Authors: Colton J Ladbury; Chad G Rusthoven; D Ross Camidge; Brian D Kavanagh; Sameer K Nath Journal: Int J Radiat Oncol Biol Phys Date: 2019-06-05 Impact factor: 7.038
Authors: Brandon L Pierce; Rachel Ballard-Barbash; Leslie Bernstein; Richard N Baumgartner; Marian L Neuhouser; Mark H Wener; Kathy B Baumgartner; Frank D Gilliland; Bess E Sorensen; Anne McTiernan; Cornelia M Ulrich Journal: J Clin Oncol Date: 2009-05-26 Impact factor: 44.544
Authors: Bernard Fisher; Stewart Anderson; John Bryant; Richard G Margolese; Melvin Deutsch; Edwin R Fisher; Jong-Hyeon Jeong; Norman Wolmark Journal: N Engl J Med Date: 2002-10-17 Impact factor: 91.245
Authors: Joseph C Y Chan; David L Chan; Connie I Diakos; Alexander Engel; Nick Pavlakis; Anthony Gill; Stephen J Clarke Journal: Ann Surg Date: 2017-03 Impact factor: 12.969