Obesity and high neutrophil-to-lymphocyte ratio are prognostic factors in non-metastatic breast cancer patients

Abstract

Obesity has been associated with an increased risk of breast cancer recurrence and death. Some readily available biomarkers associated with systemic inflammation have been receiving attention as potential prognostic indicators in cancer, including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). This study aimed to explore the correlation between body mass index (BMI) and invasive breast cancer and the association of NLR, PLR, and BMI with breast cancer outcomes. We undertook a retrospective study to evaluate patients treated for breast cancer over 14 years. Clinicopathological data was obtained before receiving any treatment. Of the 1664 patients included with stage I-III, 567 (34%) were obese (BMIX30 kg/m 2 ). Obese patients had larger tumors compared to non-obese patients. Higher BMI was associated with recurrence and worse survival only in patients with stage I disease. NLR and PLR were classified into high and low level groups. The NLR high (NLR44) was found to be an independent prognostic factor for recurrence and mortality, while the PLR high (PLR4150) group had no impact on survival. A subgroup of patients with NLR high and BMI high had the worst disease-free survival (P=0.046), breast cancer-specific survival (Po0.001), and overall survival (P=0.006), compared to the other groups. Patients with early-stage breast cancer bearing NLR high and BMI high had worse outcomes, and this might be explained by the dysfunctional milieu of obesity in adipose tissue and its effects on the immune system. This study highlights the importance of lifestyle measures and the immune system interference with clinical outcomes in the early breast cancer setting.

Pan-Immune-Inflammation Value: A New Prognostic Index in Operative Breast Cancer

“…As to PLR and SII, the univariate analysis, showed that neither PLR nor SII was a potential factor associated with OS for breast cancer in our study. The relationship between NLR, PLR, SII, and breast cancer prognosis is complex: many reports concluded that NLR ( 14 , 40 , 41 ), PLR ( 37 , 42 , 43 ), and SII ( 16 , 44 , 45 ) were independent prognostic factors for breast cancer, but there are also many studies that do not support the conclusion mentioned above ( 46 – 49 ). This may be related to the selection of the population and the included variables.…”

The influence of body mass index on the tolerability and effectiveness of full-weight-based paclitaxel chemotherapy in women with early-stage breast cancer

“…It has to be noted that chemotherapy regimens in these studies differed, which may explain the differences observed in these studies. A potential explanation for the decreased risk of hematologic toxicity in obese patients is the presence of chronic inflammation leading to increased neutrophil counts [26][27][28].…”

Neutrophils Actively Contribute to Obesity-Associated Inflammation and Pathological Complications

“…Accordingly, the NLR has been found to be significantly higher in obese individuals than in healthy lean individuals [ 132 , 133 , 134 , 135 ], with a positive correlation to the BMI [ 132 , 135 , 136 , 137 , 138 ]. As expected, the NLR is also associated with higher plasma CRP concentrations [ 111 , 132 , 139 , 140 ].…”

“…The significant association between obesity and a high NLR (higher than 4) was a good predictor of increased breast cancer risk. Patients with a high NLR and a high BMI also had the worst disease-free survival [ 133 , 138 ]. More importantly, NLR values were found to correlate significantly with the degree of abdominal obesity [ 141 , 142 ].…”