Neutrophil to lymphocyte ratio (NLR) for prediction of distant metastasis-free survival (DMFS) in early breast cancer: a propensity score-matched analysis

Orditura, Michele; Galizia, Gennaro; Diana, Anna; C, Saccone; Cobellis, Luigi; Ventriglia, Jole; Iovino, Francesco; Romano, Ciro; Morgillo, Floriana; Mosca, Lavinia; Diadema, Maria Rosaria; Lieto, Eva; Procaccini, E; Vita, Ferdinando De; Ciardiello, Fortunato

doi:10.1136/esmoopen-2016-000038

Cited by 73 publications

(71 citation statements)

References 43 publications

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“…Similar to elevated platelet count, high PLR has been found to be associated with worse survival in a variety of solid (hepatocellular, ovarian, cervix, colorectal, bile duct, breast, lung, renal cell, gastric, prostate, and oesophageal) tumours [30][31][32][33][34][35][36][37][38][39][40]. Moreover, several studies confirmed the relationship between elevated NLR and a worse prognosis in patients with malignant oesophageal [41], colorectal [42,43], pancreas [44,45], prostate [46,47], hepatic [48,49], bile duct [50], breast [51], gastric [52,53], cutaneous melanocytic [54], thyroid medullary [55], and lung [56] tumours. It is important to note, however, that NLR may be elevated also in many benign disorders [57,58].…”

Section: Discussionmentioning

confidence: 93%

Neutrophil-To-Lymphocyte and Platelet-To-Lymphocyte Ratios as Prognostic Markers of Survival in Patients with Head and Neck Tumours—Results of a Retrospective Multicentric Study

Szilasi

Jósa

Zrubka

et al. 2020

IJERPH

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Background: The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) may be useful for drawing conclusions about the survival of head and neck squamous cell carcinoma (HNSCC) patients. Methods: Clinical data of 156 patients managed for HNSCC at two head and neck surgery centres were analyzed retrospectively. We studied the relationships between survival and PLR as well as NLR. Results: With regards to 5-year survival, the difference between the two groups with PLR values lower or higher than the threshold was statistically significant (p = 0.004), and we found the same for disease-free survival (p = 0.05), and tumour-specific mortality (p = 0.009). Concerning NLR, the difference in tumour-specific survival was statistically significant (p = 0.006). According to the multivariate analysis, NLR values higher than the threshold indicated an enhanced risk for overall as well as for tumour-specific mortality. Conclusion: In HNSCC patients, a high NLR may be considered as an independent risk factor for 5-year overall survival.Malignant tumours influence the number of platelets and alter their functioning. However, the mechanisms of the relationship between thrombocytosis and the tumour have not yet been fully elucidated and several hypotheses have been proposed [2].The facilitatory role of chronic inflammation in the development and progression of solid tumours have been described for malignancies of the lung, breast, and gastrointestinal tract, the prostate, and the ovaries [3-7], as well as for HNSCC [8,9].Neutrophils might, in fact, facilitate tumour growth and the formation of metastases-these cells can inhibit the activities of the lymphocytes and thereby attenuate the antitumour immune response [10]. Neutrophil cells can contribute to carcinogenesis and tumour progression in many ways [11]: (1) These cells can release genotoxic substances, which damage the DNA of epithelial cells [12]. (2) They can promote tumour growth by releasing soluble factors and proteases, such as prostaglandin E2 and neutrophil elastase [13,14]. (3) Neutrophils facilitate metastasis formation by enhancing the capabilities of the tumour cells for migration, invasive spread, and colony formation, as well as by breaking down the extracellular matrix [15]. (4) They contribute to the formation of new blood vessels by producing pro-angiogenic factors, such as matrix metalloproteinase-9, and vascular endothelial growth factor [16]. (5) Neutrophils exert immunosuppressive action by inhibiting effector T-cells along with the proliferation and the functioning of natural killer cells, as well the fact that they enhance tumour growth and metastasis formation through the modulation of macrophage activity [17].These observations suggest that neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) determined in the blood of patients with a malignancy might be related to tumour growth [18].Our study intended to ascertain whether pre-treatment NLR and PLR values determined in HNSCC patients are suitable predi...

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Section: Discussionmentioning

confidence: 93%

Neutrophil-To-Lymphocyte and Platelet-To-Lymphocyte Ratios as Prognostic Markers of Survival in Patients with Head and Neck Tumours—Results of a Retrospective Multicentric Study

Szilasi

Jósa

Zrubka

et al. 2020

IJERPH

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“…(2) Patients Receiving Adjuvant Treatment Twenty-three studies reported data on NLR as a prognostic factor in patients with localized BC receiving adjuvant treatment . Most studies (n = 18; 78%) included patients with all BC molecular subtypes [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]. four included only patients withTNBC [49][50][51][52], and one work included patients with onlyhormone receptor-negative BC (independently of the HER2 status) [53].…”

Section: Results On Other Inflammatory Blood Markersmentioning

confidence: 99%

Section: Results On Nlr and Dfsmentioning

confidence: 99%

“…Studies including All BC Molecular Subtypes: seventeen studies analyzed the correlation between NLR and DFS after adjuvant chemotherapy [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]. In the univariate analysis, NLR was correlated with DFS in 14/17 articles (82%) [34,35,[37][38][39][40][41][42][44][45][46]46,47]. Among the 13 studies where multivariate models were used [34,35,[37][38][39][40][41][42]44,[46][47][48], only eight found that NLR was an independent prognostic factor for DFS [34,[37][38][39][40]46,48].…”

Section: Results On Nlr and Dfsmentioning

confidence: 99%

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

Corbeau

Jacot

Guiu

2020

Cancers

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Inflammatory blood markers (IBM), such as the neutrophil to lymphocyte ratio (NLR), have emerged as potential prognostic factors in various cancers, including breast cancer (BC), potentially allowing an easy, minimally invasive evaluation of a given cancer‘s prognosis and treatment outcome. We report here a systematic overview of the published data evaluating NLR as a prognostic factor or predictive factor for pathological complete response (PCR) and toxicity in early and advanced BC. A total of 45 articles were identified. NLR was found to be an independent prognostic factor for survival in most of the adjuvant treatment studies. However, no significant correlation was found between survival and NLR for early BC patients receiving neo-adjuvant chemotherapy (NACT) and advanced BC patients. Most studies failed to find a significant correlation between NLR and PCR after NACT. Finally, some data showed that IBM could be predictive of chemotherapy-related toxicity.

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“…Also, a low NLR predicted for better OS and DFS (HR was 1.6 and 1.5, respectively) (Jia et al, 2015). Other studies also demonstrated a NLR/DFS association (Orditura et al, 2016).…”

Section: Characteristicsmentioning

confidence: 94%

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

Rivas

Acevedo

Domı́nguez

et al. 2019

Asian Pac J Cancer Prev

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Objective: Tumor response to neoadjuvant chemotherapy (NAC) in breast cancer (BC) patients is a predictor for overall survival. The aim of our study was to determine a relationship between the neutrophil to lymphocyte ratio (NLR) prior to NAC, BC subtypes and the probability of a pathologic complete response (pCR). Materials and Methods: Medical records were collected retrospectively from Centro de Cancer at Red Salud UC-Christus. Clinical data collected included peripheral blood cell counts, BC subtype at diagnosis and the pathology report of surgery after chemotherapy. Results: A total of 88 patients were analyzed. Approximately, a 25% had a pCR, and displayed a significant correlation between BC subtype and pCR (p= 0.0138 Chi2); this was more frequent in epidermal growth factor receptor type 2 (HER2) enriched subtype patients (54%). Luminal B BC patients with a pCR had significantly lower NLR levels (t test, p= 0.0181). Conclusions: HER2-enriched tumors had a higher probability of pCR. In Luminal B tumors, NLR had a statistically significant relationship with the probability of pCR. In this subtype, NLR could be a useful biomarker to predict tumor response to NAC. Further studies including other clinical parameters for systemic inflammation such as platelet counts, intratumoral NLR or body mass index could help identify patients that would get the most benefit from NAC.

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Neutrophil to lymphocyte ratio (NLR) for prediction of distant metastasis-free survival (DMFS) in early breast cancer: a propensity score-matched analysis

Cited by 73 publications

References 43 publications

Neutrophil-To-Lymphocyte and Platelet-To-Lymphocyte Ratios as Prognostic Markers of Survival in Patients with Head and Neck Tumours—Results of a Retrospective Multicentric Study

Neutrophil-To-Lymphocyte and Platelet-To-Lymphocyte Ratios as Prognostic Markers of Survival in Patients with Head and Neck Tumours—Results of a Retrospective Multicentric Study

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

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

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