Neutrophil/Lymphocyte ratio has no predictive or prognostic value in breast cancer patients undergoing preoperative systemic therapy

Abstract

BackgroundThe primary goal of preoperative systemic treatment (PST) in patients with breast cancer is downsizing of tumors to enhance the rate of breast conserving surgery. Additionally, preoperative systemic treatment offers the possibility to assess for chemosensitivity of early stage disease. In various cancers the prognostic value of neutrophil/lymphocyte ratio (NLR) was demonstrated, indicating that high NLR determines worse prognosis of the patients. The goal of our study was to evaluate the predictive and prognostic value of NLR in early stage breast cancer patients undergoing PST.Methods247 female patients with histologically proven breast cancer were analysed in this retrospective analysis. The NLR before the initiation of PST was documented. Histopathological response in surgically removed specimens was evaluated using a modified Sinn regression score and the pCR defined as no invasive tumor in primary tumor and lymph nodes. NLR was correlated with response to PST and disease free survival.ResultsPST was categorized into five groups (anthracycline containing, anthracycline and taxane containing, taxane containing, hormone treatment and other chemotherapies). pCR rate was defined as no invasive rest of tumor either in primary tumor or (ypT0 = Sinn) or in primary tumor and in lymph nodes (ypT0isypN0). Median NLR in patients without any invasive tumor rest was significantly higher than in patients either with some invasive tumor rest or not responding to chemotherapy. Despite this primary difference, the results were not stable across the analysed treatment groups particularly in the group with highest pCR rates (taxane and anthracycline treatment). Further, no association with disease free survival could be observed.ConclusionsAlthough there was a reverse trend with the higher NLR prior to systemic treatment in patients who achieved pCR, we could not demonstrate predictive or prognostic value of NLR in the cohort of early stage breast cancer patients treated with PST.

Neutrophil–Lymphocyte Ratio Predicts Response to Chemotherapy in Triple-Negative Breast Cancer

“…However, the role of the nlr as a predictive and prognostic marker has not always been clear. Several studies reported no association between the nlr and prognosis 45,46 . However, those negative reports included many patients with er-positive breast cancers (approximately 50%) known to be insusceptible to nac.…”

The Neutrophil to Lymphocyte Ratio Predicts the Response to Neoadjuvant Chemotherapy in Luminal B Breast Cancer

“…In contrast, Erylmaz (2014) did not find an association between NLR and pCR in a Turkish cohort (n=78). Similarly, Suppan (2015) evaluated 247 Austrian women that received chemo or hormone neoadjuvant therapy and did not find a significant association. Asano (2016) reported that a NLR < 3 was associated to better treatment response in a Japanese cohort (n=177).…”

Neutrophil to Lymphocyte Ratio as Prognostic and Predictive Factor in Breast Cancer Patients: A Systematic Review

“…(1) Patients Receiving Neo-Adjuvant Therapy Ten studies reported data on NLR as a predictive or prognostic factor in patients receiving neo-adjuvant therapy [22][23][24][25][26][27][28][29][30][31]. Among these studies, eight included patients with all molecular subtypes [22][23][24][25][26][27][28][29], one included only patients with triple negative BC (TNBC) [31] and the last one included only patients with hormone receptor-positive/HER2-negative BC [30]. The NLR cut-off for the statistical analyses was between 1.7 and 3.33, and was computed by a receiver operating characteristic (ROC) curve analysis in all studies.…”