The Role of Neutrophil-to-Lymphocyte Ratio in Predicting Pathological Response for Resectable Non–Small Cell Lung Cancer Treated with Neoadjuvant Chemotherapy Combined with PD-1 Checkpoint Inhibitors

Xiaoyan Sun,Yingnan Feng,Bin Zhang,Wuhao Huang,Xiaoliang Zhao,Hua Zhang,Dongsheng Yue,Changli Wang 대한암학회 2022 Cancer Research and Treatment Vol.54 No.4

Purpose The aim of our study was to investigate the value of baseline and preoperative neutrophil-to-lymphocyte ratio (NLR) in predicting the pathological response and disease-free survival (DFS) of neoadjuvant chemotherapy alone or combined with programmed cell death-1 (PD-1) checkpoint inhibitors in patients with resectable non–small cell lung cancer (NSCLC). Materials and Methods Resectable NSCLC patients who underwent neoadjuvant chemotherapy alone or combined with PD-1 checkpoint inhibitors between January 2018 and January 2020 were included. Peripheral venous blood samples of the patients were collected within 3 days prior to the first neoadjuvant treatment and within 3 days prior to surgery. Results A total of 79 patients in neoadjuvant chemotherapy combined with PD-1 checkpoint inhibitors group and 89 patients in neoadjuvant chemotherapy alone group were included. Thirty-five point four percent of the patients achieved pathological complete response (pCR) in neoadjuvant chemotherapy combined with PD-1 checkpoint inhibitors group, whereas only 9.0% reached pCR in the group of neoadjuvant chemotherapy. High NLR level were correlated with poor pathological response and DFS in neoadjuvant chemotherapy or combined with PD-1 checkpoint inhibitors group. Multivariate analysis revealed that baseline NLR could independently predict pathological response and DFS in the neoadjuvant chemotherapy combined with PD-1 checkpoint inhibitors group. Conclusion High NLR level were correlated with poor pathological response and shorter DFS in patients with NSCLC undergoing neoadjuvant chemotherapy or combined with PD-1 checkpoint inhibitors. Meanwhile, baseline NLR could independently predict response to pathological response and DFS, revealing its potential as a screening tool in NSCLC patients who received neoadjuvant chemotherapy combined with PD-1 checkpoint inhibitors.

Doxetaxel과 Adiramycine을 이용한 수술전 항암화학요법; 반응률에 영향을 미치는 임상병리학적 인자

류동원,전창완,이충한 한국유방암학회 2008 Journal of breast cancer Vol.11 No.2

Purpose: The objective of this study was to test the efficacy and toxicity of adriamycin plus docetaxel as the primary chemotherapy for women with advanced breast carcinoma, and including those patients with inflammatory breast cancer. Our study also evaluated the clinicopathologic factors influencing the response rate to neoadjuvant chemotherapy. Methods: 28 patients who underwent neoadjuvant chemotherapy between 2001 and 2003 were included for this study. The patients were treated with adriamycin(50 mg/m2; intravenous bolus) followed by docetaxel (75mg/m2; 1-hour intravenous infusion) on the first day of each cycle for an average four cycles. We analysed the response rate to adjuvant chemotherapy by reviewing the post operative pathologic report. Additionally we compared the clincopathologic factors related to the response rate. Statistical analyses were performed with χ2-tests and using SPSS 11.0 Results: The mean age at diagnosis was 48.9 years old(range 29~63). The tumoral response to neoadjuvant chemotherapy was, 3 patients(10%) showed a CR(complete response), 21 patients(73.3%) showed a PR(partial response). and which about lymph node were that 7 patients(23.3%) have shown CR, 16 patients(56.6%) have shown PR. The overall response rate to neoadjuvant chemotherapy was 87.5%. The preoperative serum-CEA level was influenced the response rate to neoadjuvant chemotherapy(p=0.014). Grade 3 or 4 neutropenia was recorded in 81.9% of the patients(59/72). Grade 3 or 4 anemia was recorded in 2.8% of the patients. Conclusion: Neoadjuvant chemotherapy with adriamycin plus docetaxel was effective treatment for patients with locally advanced breast cancer. The preoperative serum CEA level colud be the important factor for the neoadjuvant chemotherapy response rate.

유방암에서 수술 전 항암화학요법이 생물학적 예후인자들에 미치는 영향

하기원(Gi Won Ha),윤현조(Hyun Jo Youn),정성후(Sung Hoo Jung) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.6

Purpose: The selection of systemic therapy for breast cancer is based on the expression pattern of biological prognostic markers. Neoadjuvant chemotherapy has been considered the standard care for locally advanced breast cancer. However, its effect on the expression of biological prognostic markers is controversial. The aim of this study was to determine whether neoadjuvant chemotherapy may alter these expression patterns in patients suffering with breast cancer. Methods: We determined the protein expression levels of estrogen receptor (ER), progesterone receptor (PR), p53 and HER-2/neu in the preoperative core needle biopsies and the final surgical specimens from 15 patients who received neoadjuvant chemotherapy between January 2002 and June 2007. As a control group, we analyzed the samples from patients who did not receive neoadjuvant chemotherapy. Results: The pathologic complete tumor response rate (pCR) of the neoadjuvant chemotherapy group was 6.7% (1/15). Of those patients who did not achieve a pCR (n=14), no significant differences in the biological prognostic markers expression were observed between the two groups. Alteration of the ER or PR status occurred in 42.8% (6/14) of the patients after neoadjuvant chemotherapy and in 14.3% (2/14) of the control patients, showing there was no significant difference between the two groups (P=0.210). The hormonal receptor status was changed in 3 cases (21.4%) after neoadjuvant chemotherapy. Conclusion: There were no significant differences for the changes in the expression of ER, PR, p53 and HER-2/neu from the preoperative core needle biopsy to the final surgical specimens between those patients who had received neoadjuvant chemotherapy and those patients who didn’t. However, changes of the ER or PR status and the hormonal receptor status occurred in 42.8% and 21.4%, respectively, of the patients who underwent neoadjuvant chemotherapy. As these changes may impact treatment, we suggest that immunohistochemical assay is necessary before and after neoadjuvant chemotherapy in patients with breast cancer.

Effect of Neoadjuvant Chemotherapy on Axillary Lymph Node Positivity and Numbers in Breast Cancer Cases

Uyan, Mikail,Koca, Bulent,Yuruker, Savas,Ozen, Necati Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.3

Background: The aim of this study is to compare the numbers of axillary lymph nodes (ALN) taken out by dissection between patients with breast cancer operated on after having neoadjuvant chemotherapy (NAC) treatment and otherswithout having neoadjuvant chemotherapy, and to investigate factors affecting lymph node positivity. Materials and Methods: A total of 49 patients operated due to advanced breast cancer after neoadjuvant chemotherapy and 144 patients with a similar stage of the cancer having primary surgical treatment without chemotherapy at the general surgery clinic of Ondokuz Mayis University Medicine Faculty between the dates 01.01.2006 and 31.10.2012 were included in the study. The total number of lymph nodes taken out by axillary dissection (ALND) was categorized as the number of positive lymph nodes and divided into <10 and ${\geq}10$. The variables to be compared were analysed using the program SPSS 15.0 with P<0.05 accepted as significant. Results: Median number of dissected lymph nodes from the patient group having neoadjuvant chemotherapy was 16 (16-33) while it was 20 (5-55) without chemotherapy. The respective median numbers of positive lymph nodes were 5 (0-19) and 10 (0-51). In 8 out of 49 neoadjuvant chemotherapy patients (16.3%), the number of dissected lymph nodes was below 10, and it was below 10 in 17 out of 144 primary surgery patients. Differences in numbers of dissected total and positive lymph nodes between two groups were significant, but this was not the case for numbers of <10 lymph nodes. Conclusions: The number of dissected lymph nodes from the patients with breast cancer having neoadjuvant chemotherapy may be less than without chemotherapy. This may not always be attributed to an inadequate axillary dissection. More research to evaluate the numbers of positive lymph nodes are required in order to increase the reliability of staging in the patients with breast cancer undergoing neoadjuvant chemotherapy.

진행된 Wilms 종양에서 수술 전 항암화학요법의 의의

강창규,문광빈,유건희,구홍회,윤혜경,박관현 대한소아과학회 2002 小兒科 Vol.45 No.12

진행된 Wilms 종양에서 수술 전 항암화학요법의 의의

강창규,문광빈,유건희,구홍회,윤혜경,박관현,Kang, Chang Kyu,Moon, Kwang Bin,Yoo, Keon Hee,Koo, Hong Hoe,Yoon, Hye Kyung,Park, Kwan Hyun 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.12

Purpose : This study was designed to exclude radiation in advanced(stage 3, 4) Wilms tumor (WT) by increasing the chance of complete surgical removal with preceding neoadjuvant chemotherapy, thereby reducing the incidence of late effects. Methods : Between December 1998 and July 2002, we conducted neoadjuvant chemotherapy after needle aspiration biopsy on patients who had advanced WT. If needle biopsy was accessible, we conducted neoadjuvant chemotherapy(vincristine, adriamycin, dactinomycin) for 12 weeks and then performed surgical removal, excluded radiation therapy and conducted postoperative chemotherapy (vincristine, dactinomycin${\pm}$adriamycin). In other cases, we firstly conducted the operation and then performed radiation and postoperative chemotherapy. Results : Of the 17 patients diagnosed as WT, 12 patients had an advanced stage of disease. In two of the 12 patients, initial surgical removal was conducted. The median age of patients was 21 months(5-103 months). Of the 10 the patients who received neoadjuvant chemotherapy, eight patients were stage 1, one patient was stage 2, and the other was stage 3 at operation. In nine patients except one with stage 3 disease, we could perform complete surgical resection and therefore could omit radiation. In four cases we could also exclude adriamycin after operation. All but one patient was alive, disease-free, for a median follow-up of 21 months(9-43 months). Conclusion : After neoadjuvant chemotherapy, we could increase the chance of complete tumor resection, exclude radiation and decrease the intensity of postoperative chemotherapy in selected cases. Long term follow-up is needed to determine whether our method would significantly decrease late effects. 목 적 : Wilms 종양은 진행된 경우에서도 수술, 방사선 치료, 항암화학요법의 병합요법으로 치료 성적이 우수하지만 방사선 치료로 인한 후기 합병증이 문제가 될 수 있다. 본 연구에서는 진행된 Wilms 종양(병기 3기, 4기)에서 수술 전 화학요법을 시행하여 종양의 완전 절제율을 높임으로써 방사선 치료를 생략하고자 하였다. 방 법 : 저자들은 1998년 12월부터 2002년 7월까지 삼성서울병원에서 Wilms 종양으로 치료를 시작한 환자 중 침 생검 후 수술 전 화학요법을 시행하였던 환자를 대상으로 하였다. 진단 시 3기, 4기의 환자에서 침 생검이 가능한 경우 수술 전 항암화학요법(vincristine, adriamycin, dactinomycin)을 12주간 시행 후 종양의 크기가 감소하면 종양 절제술을 시행하였고 완전 절제가 된 경우 방사선 치료를 생략하고 수술 후 화학요법(vincristine, dactinomycin${\pm}$adriamycin)을 시행하였다. 침 생검이 기술적으로 어렵거나 위험하다고 생각되었던 경우에는 먼저 수술적으로 종양을 절제하고 방사선 치료와 화학요법을 시행하였다. 결 과 : 연구기간 중 삼성서울병원에서 치료를 시작한 17례의 Wilms 종양 중 3기, 4기는 12례였고 이중 2례에서는 침생검이 불가능하여 먼저 수술적으로 종양을 절제하였고 침생검이 가능하였던 경우는 10례였다. 이들의 진단 시 정중 연령은 21개월(5개월-103개월)이었고, 진단 후 정중 추적기간은 31개월(9개월-44개월)이었다. 수술 전 화학요법을 시행한 10례 중 2례를 제외한 8례에서 수술시 병기가 1기로 하향화되었으며, 수술시 병기가 2기였던 1례와 함께 총 9례에서 종양의 완전절제가 가능했고 방사선 치료도 생략할 수 있었다. 이들 중 4례에서는 adriamycin도 치료에서 제외하였다. 종양의 완전 절제에 실패한 1례는 결국 사망하였고, 1례는 재발하였으나 강화된 항암화학요법과 수술로 다시 관해에 도달하여 현재 10례 중 9례가 무병 생존 중이다. 결 론 : 진행된 Wilms 종양에서 수술 전 화학요법을 시행하여 종양의 완전 절제율을 높이고 방사선 치료를 생략할 수 있었으며, 일부 환자에서는 수술 후 화학요법의 강도를 감소시킬 수 있었다. 향후 생존율의 저하 없이 후기 합병증을 줄일 수 있을 지에 대한 연구가 필요할 것으로 사료된다.

Neoadjuvant chemotherapy in ovarian, primary peritoneal and tubal carcinoma: can imaging results prior to interval debulking predict survival?

Joseph Menczer,Irena Usviatzov,Erez Ben-Shem,Abraham Golan,Tally Levy 대한부인종양학회 2011 Journal of Gynecologic Oncology Vol.22 No.3

Objective: To assess whether there is an association between improvement of computed tomography imaging results prior to interval debulking with survival in patients treated by neoadjuvant chemotherapy. Methods: The clinical and outcome data of all advanced ovarian, primary peritoneal and tubal carcinoma patients who after diagnosis had neoadjuvant chemotherapy and underwent interval debulking during the period 2000-2010, were abstracted. Results of computed tomography imaging at diagnosis and prior to interval debulking were compared. Two parameters were assessed: the change of the size and number of abnormal findings and the change in the amount of ascites. CA-125 level response was also calculated. An assessment of progression free survival and of survival by the Kaplan-Meier method was made according to the change in computed tomography imaging results and according to response of CA-125 levels. Results: The median progression free survival and the median survival of the 37 study group patients were 7.9 and 49.2 months respectively. No significant difference in progression free survival and survival was observed between patients with marked improvement in the computed tomography results and those with less desirable results (7.93 vs. 7.23 months respectively, p=0.89; 45.8% vs. 52.5% months respectively, p=0.95). There were also no statistically significant difference according to CA-125 level response. Conclusion: It seems that neither improvement in imaging results nor CA-125 level response can predict the survival of ovarian carcinoma patients prior to interval debulking after neoadjuvant chemotherapy. Objective: To assess whether there is an association between improvement of computed tomography imaging results prior to interval debulking with survival in patients treated by neoadjuvant chemotherapy. Methods: The clinical and outcome data of all advanced ovarian, primary peritoneal and tubal carcinoma patients who after diagnosis had neoadjuvant chemotherapy and underwent interval debulking during the period 2000-2010, were abstracted. Results of computed tomography imaging at diagnosis and prior to interval debulking were compared. Two parameters were assessed: the change of the size and number of abnormal findings and the change in the amount of ascites. CA-125 level response was also calculated. An assessment of progression free survival and of survival by the Kaplan-Meier method was made according to the change in computed tomography imaging results and according to response of CA-125 levels. Results: The median progression free survival and the median survival of the 37 study group patients were 7.9 and 49.2 months respectively. No significant difference in progression free survival and survival was observed between patients with marked improvement in the computed tomography results and those with less desirable results (7.93 vs. 7.23 months respectively, p=0.89; 45.8% vs. 52.5% months respectively, p=0.95). There were also no statistically significant difference according to CA-125 level response. Conclusion: It seems that neither improvement in imaging results nor CA-125 level response can predict the survival of ovarian carcinoma patients prior to interval debulking after neoadjuvant chemotherapy.

유방암에 대한 술전항암화학요법(Neoadjuvant Chemotherapy)의 반응도에 따른 잔여종양조직의 병리학적 특성

김종완(Jong Wan Kim),정성구(Sung Ku Jung),엄태익(Taeik Eum),구본용(Bon Young Koo),강희준(Hee Joon Kang),김이수(Lee Su Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.1

Purpose: There are questions about selecting the best postoperative chemotherapeutic regimen for breast cancer patients who have different response rates after neoadjuvant chemotherapy. The aim of this study was to examine the pathologic findings of residual tumors according to the response rate after neoadjuvant chemotherapy for breast cancer. Methods: We obtained specimens of residual tumors from 43 breast cancer patients who received neoadjuvant chemotherapy followed by curative operation at the Department of Breast and Endocrine Surgery, Sacred Heart Hospital, between Oct. 2002 and Oct. 2006. Four patients received 3 cycles of FAC (5-FU, Adriamycin, Cyclophosphamide) and 39 patients received 3 cycles of AT (Adriamycin, Docetaxel). We analyzed the pathologic characteristics according to the response rate. Results: The clinical response rate for neoadjuvant chemotherapy was 69.8%. There was no significant difference in the response rate for neoadjuvant chemotherapy between the AT and the FAC regimen groups. The tumors of the complete response group showed to be more ER-negative, PR-positive, p53-negative and c-erb-B2-positive and they had a lower Ki-67 staining index than the tumors of the partial response group. Moreover, the tumors of the clinical complete response group showed more triple (ER/PR/c-erb-B2) negative tumor than did the tumors of the partial response group. Conclusion: Although the tumor responded to neoadjuvant chemotherapy, the pathologic findings of the residual tumors in the clinical complete response group differed from that of the partial response group. So, this should be considered for the selection of postoperative chemotherapeutic agents.

Prognostic factors in patients with locally advanced breast cancer treated with neoadjuvant taxane-anthracycline combination chemotherapy

Chang-Eun Jang(장창은),Je-Ryoung Kim(김제룡) 대한종양외과학회 2015 Korean Journal of Clinical Oncology Vol.11 No.2

국소 진행성 유방암 환자에서 선행 항암화학요법의 치료결과

배선현,박원,허승재,최두호,남희림,양정현,남석진,이정언,임영혁,안진석,박연희 대한방사선종양학회 2010 Radiation Oncology Journal Vol.28 No.2

Purpose: To evaluate the result of neoadjuvant chemotherapy, surgery, and radiation therapy in locally advanced breast cancer as well as analyze the prognostic factors affecting survival. Materials and Methods: One hundred fifty-nine patients with breast cancer were treated by neoadjuvant chemotherapy between April 1995 and November 2006 at the Samsung Medical Center. Among these patients, we retrospectively reviewed 105 patients treated with neoadjuvant chemotherapy followed by surgery and radiation therapy for a cure with an initial tumor size >5 cm or clinically positive lymph nodes. All patients received anthracycline based chemotherapy except for 2 patients. According to clinical tumor stage, 3 patients (3%) were cT1, 26 (25%) were cT2, 39 (37%) were T3 and 37 (35%) were T4. Initially, 98 patients (93%) showed axillary lymph node metastasis. The follow-up periods ranged from 7∼142 months (median, 41 months) after the beginning of neoadjuvant chemotherapy. Results: Locoregional failure free survival rate and distant metastasis free survival rate at 5 years were 82.1% and 69.9%, respectively. Disease free survival rate and overall survival rate at 5 years were 66.1% and 77.1%, respectively. The results of a univariate analysis indicate that clinical tumor stage, pathologic tumor stage, pathologic nodal stage and pathologic TNM stage were statistically significant factors for disease free survival rate and overall survival rate. Whereas, a multivariate analysis indicated that only hormone therapy was a statistically significant factor for survival. Conclusion: The current study results were comparable to other published studies for neoadjuvant chemotherapy for breast cancer. Hormone therapy was a statistically significant prognostic factor. The patients with early clinical or pathologic stage had a tendency to improve their survival rate. 목 적: 국소 진행성 유방암으로 선행 항암화학요법 후 수술과 방사선치료를 시행한 환자를 대상으로 치료 결과와 예후에 영향을 미치는 인자를 알아보고자 하였다. 대상 및 방법: 1995년 4월부터 2006년 11월까지 삼성서울병원에서 유방암으로 선행 항암화학요법을 받은 환자는 총 159명이었다. 이중에서 진단 당시 종양의 크기가 5.0 cm를 초과하거나 액와림프절 전이가 의심된 유방암 환자로 항암화학요법 후 근치적 수술을 시행하고 방사선치료가 시행된 105명을 대상으로 하였다. 선행 항암화학요법은 2명을 제외한 모든 환자에서 anthracycline을 기반으로 하는 복합항암요법을 사용하였다. 치료 전 임상적 병기는 T1 3명(3%), T2 26명(25%), T3 39명(37%), T4 37명(35%)이었고 액와림프절 전이가 의심되는 사람이 98명(93%)이었다. 선행 항암화학요법을 시작한 날을 기준으로 추적 조사하였고 중앙추적조사기간은 41개월(7∼142개월)이었다. 결 과: 전체 환자의 5년 국소제어율은 82.1%, 원격전이제어율은 69.9%, 무병생존율은 66.1%, 전체생존율은 77.1%이었다. 무병생존율과 전체생존율에 영향을 미치는 인자를 알아보기 위해 단변량분석을 시행하였을 때 임상적 원발병소 병기, 병리학적 원발병소 병기, 병리학적 림프절 병기 그리고 병리학적 TNM 병기가 공통적으로 통계적으로 유의한 인자들이었다. 다변량 분석을 시행하였을 때 호르몬치료 유무만 생존율과 연관된 의미 있는 인자였다. 결 론: 본 연구를 통하여 삼성서울병원에서 국소 진행성 유방암으로 선행 항암화학요법이 시행된 환자의 치료 성적이 지금까지 보고된 다른 선행 항암화학요법 치료 결과와 비교할 때 비슷하거나 나은 결과를 보여주었다. 또한, 호르몬치료를 시행한 경우에만 생존율이 의미 있게 좋았고 임상적 병기나 병리학적 병기가 낮은 경우 생존율이 좋은 경향을 보였다.