<p>Prognostic Significance of Inflammatory Biomarkers in Patients with Breast Cancer Skeletal Metastases</p>

Abstract

Purpose: Skeletal metastases are a common problem in breast cancer patients. Identifying new prognostic factors can improve survival estimations and guide healthcare professionals in therapeutic decision-making. Our study aimed to determine the prognostic value of inflammatory biomarkers such as neutrophil-to-lymphocyte ratio (NLR), lymphocyte-tomonocyte ratio (LMR), and C-reactive protein/albumin ratio (CAR) in patients with breast cancer skeletal metastases. Patients and Methods: Clinical data from 212 patients with breast cancer skeletal metastases were retrospectively analyzed. The optimal cutoff values of each inflammatory biomarker were extracted from the receiver operating characteristic (ROC) curves. Patients were divided into high-value and low-value groups according to the cutoff values of NLR, LMR, and CAR. We investigated the relationship between inflammatory biomarkers and clinicopathological characteristics. The Kaplan-Meier method was used to measure progression-free survival (PFS) and overall survival (OS). The survival difference was compared by the univariate analysis. Cox multivariate regression analysis was performed to identify independent prognostic factors. Results: The median age of the patients was 55 years, and the median follow-up was 45 months. LMR<3.43 (P<0.0001), NLR≥2.48 (P<0.0001), and CAR≥0.34 (P=0.035) were found to be associated with worse PFS in the univariate analysis. Meanwhile, LMR<3.43 (P<0.0001), NLR≥2.48 (P<0.0001), and CAR≥0.34 (P=0.025) were linked to the poor OS. The multivariate analysis revealed that NLR≥2.48 (HR 2.044, P=0.007) and LMR<3.43 (HR 0.532, P=0.012) were independent prognostic factors for OS; LMR<3.43 (HR 0.501; P=0.006) and NLR≥2.48 (HR 1.971, P=0.011) were similarly prognosticating worse PFS. Radiotherapy to the affected bone and ER (+) was favorable for the prognosis of breast cancer skeletal metastases. The number of involved sites of bone metastases>3 was adverse for PFS. Conclusion: LMR<3.43 and NLR≥2.48 were independently associated with worse prognosis of patients of breast cancer skeletal metastases.

Development and validation of a nomogram to predict survival for advanced male breast cancer

“…About 20%–30% of breast cancer patients with early age will finally develop metastatic lesions (Early Breast Cancer Trialists' Collaborative G, 2005; Xie et al, 2019). For female patients, plenty of studies had investigated various markers to monitor disease change as to react timely (Huang, Hua, et al, 2020; Wang et al, 2020; Yang et al, 2020). However, there were a few researches about predictive model for metastatic male patients.…”

Prognostic Significance of Neutrophil-to-Lymphocyte Ratio and C-Reactive Protein/Albumin Ratio in Luminal Breast Cancers With HER2-Negativity

“…Zhou et al (9) reported that an increased preoperative CAR (≥0.029) was an independent risk factor for decreased OS (HR, 9.189; P=0.003) and DFS (HR, 2.225; P=0.024) in patients with non-metastatic BC. By contrast, Wang et al (21) identified that there was no association between elevated CAR (≥0.34) and the survival of BC patients with skeletal metastases in multivariate analysis. There are several explanations for these contradicting results such as differences in the optimal cut-off value for CAR, the selection of study subjects, the timing of the pre-treatment blood samples and the follow-up time.…”

“…By contrast, Wang et al. ( 21 ) identified that there was no association between elevated CAR (≥0.34) and the survival of BC patients with skeletal metastases in multivariate analysis. There are several explanations for these contradicting results such as differences in the optimal cut-off value for CAR, the selection of study subjects, the timing of the pre-treatment blood samples and the follow-up time.…”

“…Recently, CAR has been reported to be an independent risk factor in several cancers, including esophageal cancer ( 17 ), gastric cancer ( 18 ), pancreatic cancer ( 19 ) and ovarian cancer ( 20 ) included, yet its prognostic role in BC remains to be elucidated. One study reported that an increased CAR before surgery was associated with a poor outcome in BC ( 9 ), yet another suggested that there was no correlation between CAR and BC outcome ( 21 ).…”

A Novel Inflammatory-Nutritional Prognostic Scoring System for Patients with Early-Stage Breast Cancer

“… 19 MLR, the ratio of monocytes and lymphocytes, is also significantly related to poor prognosis of breast cancer patients. 45 Serum albumin, a routine item tested in clinical practice, has been explored as an independent parameter of clinical outcomes in some malignancies, including breast cancer, and a reduction in the albumin level indicates malnutrition, which might lead to a poor prognosis in cancer patients. 24 , 46 The PNI was summed using serum albumin levels and the peripheral lymphocyte counts, which have been proven to reflect the nutritional status of patients and are associated with their survival in many studies.…”