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Hubungan antara Platelet Lymphocyte Ratio (PLR) dan respon Neoadjuvant Chemotherapy (NAC) CAF pada pasien Locally Advanced Breast Cancer



Abstract

Background: The incidence of LABC (Locally Advanced Breast Cancer) in Indonesia is estimated more than 50%, and in Bali as many as 76.3% from all of breast cancer cases. Response of NAC (Neoadjuvant chemotherapy) in LABC case is not the same on each patient. Currently, there are several biomarkers that can be a predictor of NAC response on LABC. One of them is PLR (platelet lymphocyte ratio). PLR is an easy, cheap and fast marker to be counted, but not all clinicians know its role. Lack of research in the relationship of PLR to NAC CAF (Cyclophospamide, Adriamycin, 5 Flourouracil) response in patients with LABC are currently making researchers interested in studying it.

Method: This research is observational analytics, using a retrospective cohort study.  The number of samples was 62 (consecutive sampling), obtained from the medical records of patients who had undergone NAC CAF from 2015-2019 at Sanglah Hospital Denpasar.  PLR value  and initial tumor size were calculated before undergoing chemotherapy, then assessed the NAC CAF response to tumors after undergoing 3 cycles of chemotherapy. Positive response if tumor size is reduced and  negative response if the tumor size is persists or enlarges. In this study use a cut off point of PLR 150.

Results: From 62 respondents obtained PLR value ≤ 150 had a positive response of 77.1% and 22.9% had a negative response. From these results obtained a correlation between PLR value with responses to NAC CAF in LABC patients, where low PLR values had  positive responses 1.6 times (IK 95; 1.04 - 2.47) with an output value of p = 0.018.

Conclusion: There is a correlation between PLR and NAC CAF response, where a low PLR value (PLR ≤ 150) has a positive response to NAC CAF in LABC patients.

 

Latar Belakang: Angka kejadian LABC (Locally Advanced Breast Cancer) di Indonesia diperkirakan lebih dari 50%, dan di Bali sebanyak 76,3% dari semua kasus kanker payudara. Respon NAC (neoadjuvant chemotherapy) pada kasus LABC tidak sama pada setiap penderita. Saat ini terdapat beberapa biomarker yang dapat menjadi prediktor terhadap respon NAC pada LABC, salah satunya adalah PLR (platelet lymphocyte ratio). PLR merupakan suatu marker yang mudah, murah dan cepat untuk dinilai tetapi masih banyak klinisi yang belum mengetahui perannya. Kurangnya penelitian mengenai hubungan PLR terhadap respon NAC CAF (Cyclophospamide, Adriamycin, 5 Flourouracil) pada pasien LABC saat ini membuat peneliti tertarik untuk meneliti hal tersebut.

Metode: Jenis penelitian analitik observasional menggunakan studi kohort retrospektif, dengan 62 responden (consecutive sampling), yang didapatkan dari rekam medis pasien yang telah menjalani NAC CAF dari tahun 2015-2019 di RSUP Sanglah Denpasar. Nilai  PLR  dan ukuran tumor awal dihitung sebelum kemoterapi, kemudian dinilai respon NAC CAF terhadap tumor setelah menjalani 3 siklus kemoterapi. Respon positif  yaitu jika terjadi reduksi ukuran tumor ≥ 30% dari ukuran tumor awal dan respon negatif  jika terjadi reduksi ukuran tumor < 30%. Penelitian ini menggunakan cut off point  PLR 150,0 yang didapatkan dari penelitian sebelumnya.

Hasil: Dari 62 responden didapatkan nilai PLR ≤ 150 mempunyai respon positif sebanyak 77,1% dan 22,9% respon negatif. Dari hasil tersebut didapatkan hubungan antara nilai PLR dengan respon terhadap NAC CAF pada pasien LABC, dimana nilai PLR rendah mempunyai respon positif sebanyak 1.6 kali (IK 95; 1.04 – 2.47) dengan hasil output nilai p = 0.018.

Kesimpulan: Terdapat hubungan antara PLR terhadap respon NAC CAF, dimana nilai PLR yang rendah (≤ 150) mempunyai respon positif terhadap NAC CAF pada pasien LABC.  


Keywords: PLR (Platelet lymphocyte ratio) NAC (Neoadjuvant chemotherapy) CAF (Cyclophospamide Adriamycin 5 Flourouracil) LABC (Locally Advanced Breast Cancer).

References

  1. Giordano SH. Update on Locally Advanced Breast Cancer. The Oncologist. 2003;8(6):521-530. doi:10.1634/theoncologist.8-6-521
  2. Costa R, Hansen N, Gradishar WJ. Locally Advanced Breast Cancer. In the breast: Comprehensive management of benign and malignant disease. Elsevier. 2018;6:819-831. https://doi.org/10.1016/B978-0-323-35955-9.00063-5
  3. Manuaba TW. Panduan Penatalaksanaan Kanker Payudara. Panduan Penatalaksanaan Kanker Solid. PERABOI. Sagung Seto. 2010; 1:18– 50
  4. Bamal R, Chintamani, Tandon M., Mittal, et al. Evaluation and Validation of Neo-Adjuvant Response Index (NRI) and It’s Correlation with Various Predictive Biomarkers and RECIST in Locally Advanced Breast Cancer. Indian Journal of Surgical Oncology. 2014; 5(3):171-177. doi:10.1007/s13193-014-0336-1
  5. Asano Y, Kashiwagi S, Onoda N, et al. Platelet Lymphocyte Ratio as a Useful Predictor of the Therapeutic Effect of Neoadjuvant Chemotherapy in Breast Cancer. Plos One. 2016; 11:7.
  6. Luangdilok S, Samarnthai N, Korphaisarn K et al. Association between Pathological Complete Response and Outcome Following Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer Patients. Journal of Breast Cancer. 2014; 17(4):376.doi:10.4048/jbc.2014.17.4.376
  7. Singh J, Singh B, Joneja A, et al. Role of Neoadjuvant Chemotherapy with Cyclophosphamide, Adriamycin, 5-Fluorouracil (CAF Regimen) in Down Staging in Breast Cancer. Annals of International medical and Dental Research. 2016;2:6. doi:10.21276/aimdr.2016.2.6.sg7
  8. Gonzales AM, Hortobagyi G N. Neoadjuvant Systemic Therapy for Breast Cancer. Breast Surgical Techniques and Interdisciplinary Management. 2010; 731-739.
  9. Angahar LT. An Overview of Breast Cancer Epidemiology, Risk Factors, Pathophysiology, and Cancer Risks Reduction. MOJ Biology and Medicine. 2017;1:4.doi:10.15406/mojbm.2017.01.00019
  10. Bufi E, Belli P, Costantini M, et al. Role of the Apparent Diffusion Coefficient in the Prediction of Response to Neoadjuvant Chemotherapy in Patients With Locally Advanced Breast Cancer. Clinical Breast Cancer. 2015; 15: 370-380. doi:10.1016/j.clbc.2015.02.002
  11. Kwan HL, Eun YK, Ji SY, et al.The prognostic and predicyive value of tumor infiltrating lymphocytes and hematologic parameters in patients with breast cancer. BMC Cancer. 2018;18:938. https://doi.org/10.1186/s12885-018-4832-5
  12. Zhu Y, Si W, Sun Q, et al. Platelet-lymphocyte ratio acts as an indicator of poor prognosis in patients with breast cancer. Oncotarget. 2016; 8 (1):1023-1030.doi:10.18632/oncotarget.13714
  13. Lopez J, Zapata A, Agudelo L, et al. Platelet Lymphocyte Ratio as a Useful Predictor of the Therapeutic Effect of Neoadjuvant Chemotherapy in Breast Cancer. PLOS ONE. 2018;13-11.
  14. Chua W, Charles KA, Baracos VE, Clarke SJ. Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer. British journal of cancer. 2011; 104(8):1288–95. Epub 2011/03/31. https://doi.org/10.1038/bjc.2011.100 PMID: 21448173; PubMed Central PMCID: PMC3078587
  15. Ohno Y, Nakashima J, Ohori M, et al. Pretreatment neutrophil to lymphocyte ratio as an independent predictor of recurrence in patients with nonmetastatic renal cell carcinoma. The Journal of urology. 2010; 184(3):873–8. Epub2010/07/21.https://doi.org/10.1016/j.juro.2010.05.028 PMID: 20643463
  16. Schmidt H, Suciu S, Punt CJ, et al. Pretreatment levels of peripheral neutrophils and leukocytes as independent predictors of overall survival in patients with American Joint Committee on Cancer Stage IV Melanoma: results of the EORTC 18951 Biochemotherapy Trial. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2007; 25(12):1562–9. Epub 2007/04/20. https://doi.org/10.1200/JCO.2006.09.0274 PMID: 17443000
  17. Azab B, Bhatt VR, Phookan J, et al. Usefulness of the neutrophil to lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Annals of surgical oncology. 2012;19(1):217–24. Epub 2011/06/04. https://doi.org/10.1245/s10434-011-1814-0 PMID: 21638095
  18. Tung NM, Winer EP. Tumor-infiltrating lymphocytes and response to platinum in triple-negative breast cancer. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2015;33(9):969–71. https://doi.org/10.1200/JCO.2014.59.6031 PMID: 25559817
  19. Yu X, Zhang Z, Wang Z, et al. Prognostic and predictive value of tumor-infiltrating lymphocytes in breast cancer: a systematic review and meta-analysis. Clinical & translational oncology: official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico. 2016; 18(5):497–506. https://doi.org/10.1007/s12094-015-1391-y PMID: 26459255; PubMed Central PMCID: PMCPMC4823351
  20. Eren Tulay, Karacin Cengiz, Ucar gokhan ,et al. Correlation between peripheral blood inflammatory indicators and pathologic complete response to neoadjuvant chemotherapy in locally advance breast cancer patients. Medicine. 2020;99:22. doi:10.1097/MD.0000000000020346

How to Cite

Wibisono, A., Christian, I. N. W. S., & Adiputra, P. A. T. (2020). Hubungan antara Platelet Lymphocyte Ratio (PLR) dan respon Neoadjuvant Chemotherapy (NAC) CAF pada pasien Locally Advanced Breast Cancer. Intisari Sains Medis, 11(2), 647–651. https://doi.org/10.15562/ism.v11i2.754
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Aryo Wibisono
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I Nengah Wiadnyana Steven Christian
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Putu Anda Tusta Adiputra
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