Delta nötrofil indeksinin aksiller metastazları belirlemede tanısal değeri

Abstract

Amaç: İnflamatuar koşullarda periferik kandaki olgunlaşmamış granülositlerin (IG) yüzdesini gösteren delta nötrofil indeksi(DNI) artan kemik iliği aktivasyonunun bir göstergesi olarak kullanılabilir.Bu çalışmanın amacı meme kanseri prognozunda önemli rol oynayan aksiller lenf nodu metastazını klinik ve radyolojik tespitinden önce IG sayısı ve DNI ile belirlemektir. Gereç ve Yöntem: Meme kanseri tanısı alıp opere edilen ve aksiller lenf nodu diseksiyonu yapılmış hastalar tarandı ve 127 hasta çalışmaya dahil edildi. Hastaların yaşı, cinsiyeti, operasyon süresi, hastanede yatış süreleri, immatür granülosit (IG) yüzdeleri (IG#) ve aksiller lenf nodu patoloji sonuçları retrospektif olarak arşiv sisteminden tarandı. Bulgular: DNI VE IG lenf nodu metastazı olan grupta istatiksel olarak daha yüksekti. IG# açısından inceleme yapıldığında lenf nodu reaktif olan grubun ortalaması 0,02±0,02 iken metastatik grubun ortalaması 0,04±0,05 bulundu, istatistiki anlamlı farklılık gösterecek şekilde yüksekti (p<0,001). Hastalar arasında metastazın ayrımı IG#’sı için %40 sensitivite ve %86,1 spesifiteyle 0,035 (OR 4,133, CI%95 0,589-0,777, p<0,001) değerleri cut-off olarak bulunmuştur. Sonuç: DNI ve IG sayısı, meme kanserinin aksiller metastazını saptamada yüksek duyarlılık ve özgüllüğe sahip yeni öngörücü belirteçler olabilir.

Keywords

• Meme kanseri
• aksiller lenf nodu metastazı
• delta nötrofil indeks
• immatur granülosit

Diagnostic value of delta neutrophil index in determining axillary metastases in breast cancer

Abstract

Aim: The delta neutrophil index (DNI), which shows the percentage of immature granulocytes (IG) in peripheral blood in inflammatory conditions, is an indicator of increased bone marrow activation. Its ability to predict prognosis has been demonstrated in many cancer studies. This study aims to investigate the value of DNI in predicting axillary metastases in breast cancer. Material and Method: Patients diagnosed with breast cancer and operated on axillary lymph node dissection were screened and 127 patients were included in the study. The patient’s age, gender, operation time, length of hospital stay, immature granulocyte (IG) percentages (IG#), and axillary lymph node pathology results were retrospectively scanned from the archive system. Results: DNI and IG were statistically higher in the group with lymph node metastasis. When examined for IG#, the mean of the group with reactive lymph nodes was 0.02±0.02, while the mean of the metastatic group was 0.04±0.05. This statistically significant difference was high (p<0.001). Cut-off values of 0.035 (OR 4.133, CI 95% 0.589-0.777, p<0.001) were found with 40% sensitivity and 86.1% specificity for the differentiation IG# of metastasis among patients. Conclusion: DNI and IG count may be new predictive markers with high sensitivity and specificity in detecting axillary metastasis of breast cancer.

Keywords

• Breast cancer
• axillary lymph node metastasis
• delta neutrophil index
• immature granulocyte

References

1. Siegal R, Ma J, Zou Z, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2014; 64: 9-29.
2. Marín Hernández C, Piñero Madrona A, Gil Vázquez PJ, et al. Usefulness of lymphocyte-to-monocyte, neutrophil-to-monocyte and neutrophil-to-lymphocyte ratios as prognostic markers in breast cancer patients treated with neoadjuvant chemotherapy. Clin Transl Oncol 2018; 20: 476-83.
3. Chen F, Liu M, Yu Y, et al. LINC00958 regulated miR-627-5p/YBX2 axis to facilitate cell proliferation and migration in oral squamous cell carcinoma. Cancer Biol Ther 2019; 20: 1270-80.
4. Saadatmand S, Bretveld R, Siesling S, Tilanus-Linthorst MM. Influencetumormour stage at breast cancer detection on survival in modern times: population-based study in 173,797 patients. BMJ 2015; 351: 4901.
5. Guthrie GJ, Charles KA, Roxburgh CS, et al. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol 2013; 88: 218-30.
6. McMillan DC. Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care 2009; 12: 223-6.
7. Templeton AJ, McNamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst 2014; 29: 106
8. Morris GJ, Naidu S, Topham AK, et al. Differences in breast carcinoma characteristics in newly diagnosed African-American and Caucasian patients: a single-institution compilation compared with the National Cancer Institute’s Surveillance, Epidemiology, and End Results database. Cancer 2007; 110: 876-84

9. Choi WJ, Cleghorn MC, Jiang H, Jackson TD, Okrainec A, Quereshy FA. Preoperative neutrophil-to-lymphocyte ratio is a better prognostic serum biomarker than platelet-to-lymphocyte ratio in patients undergoing resection for nonmetastatic colorectal cancer. Ann Surg Oncol 2015; 3: 603-13.
10. Nishijima TF, Muss HB, Shachar SS, Tamura K, Takamatsu Y. Prognostic value of lymphocyte-to-monocyte ratio in patients with solid tumors: A systematic review and meta-analysis. Cancer Treat Rev. 2015; 41: 971-78.
11. Sanjay P, Figueiredo RS, Leaver H, et al. Preoperative serum C-reactive protein levels and post-operative lymph node ratio are important predictors of survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. J Pancreat Cancer 2012; 13: 199-204
12. Bozan MB, Yazar FM, Kale İT, Yüzbaşıoğlu MF, Boran ÖF, Azak BA. Delta neutrophil index and neutrophil-to-lymphocyte ratio in the differentiation of thyroid malignancy and nodular goiter. World J Surg 2021; 45: 507-14
13. Bozan MB, Yazar FM, Güler Ö, Azak BA, Boran ÖF. Preoperative immature granulocyte count and percentage for complicated acute appendicitis and uncomplicated acute appendicitis (A retrospective cohort study). Med Sci 2021; 25: 760-6.
14. Ahn C, Kim W, Lim TH, Cho Y, Choi KS, Jang BH. The delta neutrophil index (DNI) as a prognostic marker for mortality in adults with sepsis: a systematic review and meta-analysis. Sci Rep 2018; 8: 6621.
15. Yune HY, Chung SP, Park YS, et al. Delta neutrophil index as a promising prognostic marker in out of hospital cardiac arrest. PLoS One 2015; 10: 0120677.
16. Shin DH, Cho YS, Cho GC et al. Delta neutrophil index as an early predictor of acute appendicitis and acute complicated appendicitis in adults. World J Emerg Surg 2017; 12: 1-6
17. Hilmy M, Bartlett JM, Underwood MA, McMillan DC. The relationship between the systemic inflammatory response and survival in patients with transitional cell carcinoma of the urinary bladder. Br J Cancer 2005; 92: 625-7.
18. Crumley AB, McMillan DC, McKernan M, McDonald AC, Stuart RC. Evaluation of an inflammation-based prognostic score in patients with inoperable gastro-oesophageal cancer. Br J Cancer 2006; 94: 637-41
19. Kim NY, Chun DH, Kim SY, et al. Prognostic value of systemic inflammatory indices, NLR, PLR, and MPV, for predicting 1-year survival of patients undergoing cytoreductive surgery with HIPEC. J Clin Med 2019; 29: 589.
20. Jamieson NB, Glen P, McMillan DC, et al. Systemic inflammatory response predicts outcome in patients undergoing resection for ductal adenocarcinoma head of pancreas. Br J Cancer 2005; 17: 21-3.
21. De Giorgi U, Mego M, Scarpi E, et al. Association between circulating tumor cells and peripheral blood monocytes in metastatic breast cancer. Ther Adv Med Oncol 2019; 14: 1758835919866065.
22. Bozkurt O, Karaca H, Berk V, et al. Predicting the role of the pretreatment neutrophil to lymphocyte ratio in the survival of early triple-negative breast cancer patients. J BUON 2015; 20: 1432-9.
23. Ünal, Yılmaz. “A new and early marker in the diagnosis of acute complicated appendicitis: immature granulocytes. Ulus Travma Acil Cerrahi Derg 2018; 24: 434-39.
24. Seok Y, Choi JR, Kim J, et al. Delta neutrophil index: a promising diagnostic and prognostic marker for sepsis. Shock 2012; 37: 242-6.
25. Barut O, Demirkol MK, Kucukdurmaz F, Sahinkanat T, Resim S. Pre-treatment delta neutrophil index as a predictive factor in renal cell carcinoma. J Coll Physicians Surg Pak 2021; 31: 156-61.
26. Lee SJ, Park EJ, Lee KJ, Cha YS. The delta neutrophil index is an early predictive marker of severe acute cholecystitis. Dig Liver Dis 2019; 51: 1593-8.
27. Shin DH, Cho YS, Cho GC et al. Delta neutrophil index as an early predictor of acute appendicitis and acute complicated appendicitis in adults. World J Emerg Surg 2017; 12: 1-6.