Neutrophil-lymphocyte ratio in metastatic breast cancer is not an independent predictor of survival, but depends on other variables

Abstract

The prognostic impact of neutrophil-lymphocyte ratio (NLR) in metastatic breast cancer (MBC) has been previously evaluated in early and metastatic mixed breast cancer cohorts or without considering other relevant prognostic factors. Our aim was to determine whether NLR prognostic and predictive value in MBC was dependent on other clinical variables. We studied a consecutive retrospective cohort of patients with MBC from a single centre, with any type of first line systemic treatment. The association of NLR at diagnosis of metastasis with progression free survival (PFS) and overall survival (OS) was evaluated using Cox univariate and multivariate proportional hazard models. In the full cohort, that included 263 MBC patients, a higher than the median (>2.32) NLR was significantly associated with OS in the univariate analysis (HR 1.36, 95% CI 1.00–1.83), but the association was non-significant (HR 1.12, 95% CI 0.80–1.56) when other clinical covariates (performance status, stage at diagnosis, CNS involvement, visceral disease and visceral crisis) were included in the multivariate analysis. No significant association was observed for PFS. In conclusion, MBC patients with higher baseline NLR had worse overall survival, but the prognostic impact of NLR is likely derived from its association with other relevant clinical prognostic factors.

Inflammation-Based Scores Increase the Prognostic Value of Circulating Tumor Cells in Primary Breast Cancer

“…Similar results, showing that early-stage BC patients with high NLR were more prone to suffer a postoperative recurrence, were published by Geng and colleagues using a cut-off of 1.88 [56]. On the other hand, the prognostic impact of NLR was not confirmed in metastatic BC by Rubio and colleagues, who used the median value cut-off of 2.32 [57]. The ratio between lymphocytes and monocytes was in the majority of the studies reported as LMR and ranged in advanced epithelial cancers between 2.35 and 5.46.…”

The complexity of neutrophils in health and disease: Focus on cancer

“…Indeed, NLR is a dynamic parameter that can undergo variations over time and can be affected by other clinical parameters, such as infections. Therefore, it remains to establish an optimal and uniform threshold to define a low, normal and high NLR in cancer patients [ 178 ].…”

A high neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are associated with a worse outcome in inflammatory breast cancer

“…Rubio et al. could not demonstrate a significant association between NLR and survival in mBC, concluding that the prognostic effect of NLR is probably derived from the association with other clinicopathological factors [ 39 ]. However, our data are consistent with the growing body of evidence suggesting that the NLR is a good, independent inflammatory prognostic biomarker, especially for OS [ 40 ].…”