Association of neutrophil-to-lymphocyte ratio with clinical, pathological, radiological, laboratory features and disease outcomes of invasive breast cancer patients: A retrospective observational cohort study

Abstract

Inflammatory conditions play part in the progression of malignancies, and markers signifying growth of these factors can indicate prognosis. Neutrophil-to-lymphocyte (NLR) is used as a marker of subclinical inflammation that may become an integral part of workup to indicate prognosis and associated pathology. This study aims to explore the association of NLR ratio with clinical characteristics, radiological assessment and staging, histopathology, and disease outcomes of breast cancer. A retrospective cohort study was conducted in a tertiary care center to include breast cancer patients that were diagnosed between January 2001 and December 2020. Data including tumor size, lymph nodes, metastasis, histological grading, ER/PR/HER2-neu status, molecular subtypes, clinical staging); nodal findings (sentinel and axillary); pathology from frozen section; and disease outcomes were assessed. Multivariable regression and Kaplan-Meier survival curves were employed to indicate the association of NLR with breast cancer features and disease-free survival. A total of 2050 patients had a median age of 50 years, median NLR levels of 2.14, most common pathology ductal followed by lobular, and most common site of metastasis being lungs followed by bones. Disease-free rate was 7.6%, and a recurrence rate of 1.8%, while 1.6% deaths were reported. NLR was found associated with age, treatment outcomes, tumor size, lymph nodes, metastasis and clinical staging. Other positive correlations were with Ki67 proliferation index, molecular subtypes, and tumor size on frozen section (at transverse and craniocaudal dimensions). Negative correlations were seen with estrogen and progesterone receptors. However, NLR was not found predictable of disease-free survival (P = .160). Significant predictors of disease-free survival were histological grading, ER, PR status, molecular subtype, and Ki67 proliferation index. NLR being a readily available marker has shown novel findings in its association with tumor staging, disease outcomes and characteristics of breast malignancy.

A Retrospective Analysis of the Association of Neutrophil–Lymphocyte Ratio (NLR) with Anemia in the Saudi Population

“…NLR was examined in sickle cell anemia and was found to be high with proteinuria and positively correlated with fibrinogen levels [ 29 ]. Furthermore, NLR and anemia were independent risk factors for mortality in breast cancer patients [ 30 ]. Elevated NLR combined with decreased Hb predicted the onset of major adverse cardiovascular events in patients with ST-elevation myocardial infarction [ 14 ].…”

The Negative Impact of Inflammation-Related Parameters in Prostate Cancer after Robot-Assisted Radical Prostatectomy: A Retrospective Multicenter Cohort Study in Japan (the MSUG94 Group)

“…Several studies have shown that many types of malignant neoplasms play an important role in the carcinogenic process and survival with respect to systemic inflammation [6][7][8][9][10][11][12][13][14][15][16]24]. Tumor cells themselves release cytokines and chemokines, which are thought to circulate and induce a systemic inflammatory response [25], resulting in changes in neutrophils, lymphocytes, and platelets [26].…”

“…Platelets have been shown to protect tumor cells from adhering to and being excluded from the vascular endothelium, thus contributing to their survival and spread [29,30]. In fact, inflammatory markers have been reported to be associated with tumor stage and grade, oncological outcome, and prognosis in various types of malignant neoplasms [5][6][7][8][9][10]. Because neutrophils, lymphocytes, and platelets have these functions with respect to tumor cells, the role of the inflammation-related parameters in PCa is of interest.…”

“…The relationships between inflammation-related parameters and tumorigenesis have been widely studied in various tumors [6][7][8][9][10]. In particular, PCa, which is a systemic, multifactorial disease, has been extensively investigated [11][12][13][14][15][16].…”