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Meta-Analysis
. 2024 May 3;111(5):znae132.
doi: 10.1093/bjs/znae132.

Predictive value of pretreatment circulating inflammatory response markers in the neoadjuvant treatment of breast cancer: meta-analysis

Gavin P Dowling  1   2   3 , Gordon R Daly  1   3 , Aisling Hegarty  1   3 , Sandra Hembrecht  1   3 , Aisling Bracken  1 , Sinead Toomey  2 , Bryan T Hennessy  2 , Arnold D K Hill  1   3
Affiliations
Meta-Analysis

Predictive value of pretreatment circulating inflammatory response markers in the neoadjuvant treatment of breast cancer: meta-analysis

Gavin P Dowling et al. Br J Surg. .

Abstract

Background: Systemic inflammatory response markers have been found to have a prognostic role in several cancers, but their value in predicting the response to neoadjuvant chemotherapy in breast cancer is uncertain. A systematic review and meta-analysis of the literature was carried out to investigate this.

Methods: A systematic search of electronic databases was conducted to identify studies that explored the predictive value of circulating systemic inflammatory response markers in patients with breast cancer before commencing neoadjuvant therapy. A meta-analysis was undertaken for each inflammatory marker where three or more studies reported pCR rates in relation to the inflammatory marker. Outcome data are reported as ORs and 95% confidence intervals.

Results: A total of 49 studies were included, of which 42 were suitable for meta-analysis. A lower pretreatment neutrophil-to-lymphocyte ratio was associated with an increased pCR rate (pooled OR 1.66 (95% c.i. 1.32 to 2.09); P < 0.001). A lower white cell count (OR 1.96 (95% c.i. 1.29 to 2.97); P = 0.002) and a lower monocyte count (OR 3.20 (95% c.i. 1.71 to 5.97); P < 0.001) were also associated with a pCR. A higher lymphocyte count was associated with an increased pCR rate (OR 0.44 (95% c.i. 0.30 to 0.64); P < 0.001).

Conclusion: The present study found the pretreatment neutrophil-to-lymphocyte ratio, white cell count, lymphocyte count, and monocyte count of value in the prediction of a pCR in the neoadjuvant treatment of breast cancer. Further research is required to determine their value in specific breast cancer subtypes and to establish optimal cut-off values, before their adoption in clinical practice.

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Figures

Fig. 1
Fig. 1
Flow diagram.
Fig. 2
Fig. 2
Meta-analysis of the association between the neutrophil-to-lymphocyte ratio and a pCR NLR, neutrophil-to-lymphocyte ratio; M–H, Mantel–Haenszel.
Fig. 3
Fig. 3
Meta-analysis of the association between the white cell count and a pCR WCC, white cell count; M–H, Mantel–Haenszel.
Fig. 4
Fig. 4
Meta-analysis of the association between the lymphocyte count and a pCR M–H, Mantel–Haenszel.
Fig. 5
Fig. 5
Meta-analysis of the association between the monocyte count and a pCR M–H, Mantel–Haenszel.
Fig. 6
Fig. 6
Meta-analysis of the association between the platelet-to-lymphocyte ratio and a pCR PLR, platelet-to-lymphocyte ratio; M–H, Mantel–Haenszel.
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