Neutrophil-to-lymphocyte ratio, obesity, and breast cancer risk in Chinese population

Fang, Qiong; Tong, Yiwei; Wang, Gen; Zhang, Nan; Chen, Weiguo; Li, Ya-Fen; Shen, Kunwei; Wu, Beiwen; Chen, Xiaosong

doi:10.1097/md.0000000000011692

Cited by 22 publications

(19 citation statements)

References 41 publications

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“…However, only three prior studies, all conducted in Asian women, assessed the association between NLR and risk of breast cancer 7,17,18 . Two of the three studies compared breast cancer cases with patients with benign breast disease (BBD) 7,17 , and only one used healthy controls as comparison group 18 , as in our study. In one of the studies 17 , NLR was significantly higher in the breast cancer group compared with the BBD group, and patients with NLR > 1.67 were associated with an increased risk of breast cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Another possibility is that a different mechanistic pathway may exist between breast cancer patients and healthy controls by menopausal status, however, we found no evidence in the literature in support of this. A previous study conducted in Chinese women using BBD as controls examined the NLR-BC association by menopausal status and found that intermediate and high NLR levels significantly increased breast cancer risk compared to very low NLR levels in both, pre-and postmenopausal women 17 . In another study of ovarian cancer cases, total neutrophil counts and WBC were significantly increased in premenopausal women who were Jewish 35 , and premenopausal women who had a family history of breast or ovarian cancer also had higher NLR and lower lymphocyte counts 35 .…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have shown that higher NLR was associated with adverse survival 4 – 9 , both disease-free survival and overall survival 11 and more advanced or aggressive breast cancer 7 , 10 , 11 . However, only three prior studies, all conducted in Asian women, assessed the association between NLR and risk of breast cancer 7 , 17 , 18 . Two of the three studies compared breast cancer cases with patients with benign breast disease (BBD) 7 , 17 , and only one used healthy controls as comparison group 18 , as in our study.…”

Section: Discussionmentioning

confidence: 99%

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Neutrophil to lymphocyte ratio and breast cancer risk: analysis by subtype and potential interactions

Gago‐Dominguez

Matabuena

Redondo

et al. 2020

Sci Rep

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Multiple studies have found the neutrophil to lymphocyte ratio (nLR) to be associated with adverse breast cancer (BC) prognosis and survival. Very limited data exist on the role of NLR and risk of BC. The BREOGAN study is a population-based case-control study conducted in Galicia, Spain. We examined the WBC-and NLR-BC relationships. The risk of BC increased with increasing levels of neutrophils percentage (NE%) (multivariable OR for the highest category (95% CI) = 2.14 (1.39-3.32), P-trend < 0.001) and of the NLR (multivariable OR for the highest category (95% CI) = 1.93 (1.26-2.97), P-trend < 0.001). Lymphocytes absolute (L#) and percentage (L%) were associated with a decreased risk of BC (multivariable OR for the highest category (95% CI) = 0.54 (0.35-0.83), and 0.51 (0.33-0.79), P-trend = 0.001 and < 0.001, respectively). The NLR-BC association was more pronounced among Luminal A BC (multivariable OR for the highest category (95% CI) = 2.00 (1.17-3.45), P-trend < 0.001), HER2-negative BC (multivariable OR for the highest category (95% CI) = 1.87 (1.16-3.02), P-trend < 0.001), and those with high total cholesterol and low H 2 o 2 levels. In 2018, 32,825 new breast cancer cases were diagnosed in Spain, representing 12% of all cancer cases, and 29% of all cancers in women 1. It was responsible for 6,421 deaths (6% of all cancer deaths). Breast cancer is the most frequent cancer in Spain and ranks the fourth in cancer-related mortality. There has been a 30% increase in breast cancer incidence between 2012 and 2018 1. High concentration of blood neutrophils is seen in patients with advanced cancer and are associated with poor survival 2,3. Similarly, there is abundant evidence for an adverse prognostic value of neutrophil to lymphocyte ratio (NLR) on breast cancer. Multiple studies have shown that higher NLR was associated with poorer survival 4-9 , and a recent meta-analysis found that higher NLR was associated with both worse disease-free survival and overall survival 6. Several previous studies have found that higher NLR was also associated with more advanced or aggressive breast cancer 3,7,10,11. For this reason, the ratios between neutrophils in blood and other leukocytes, as the NLR, have been suggested as a prognostic value in cancer 3,12,13. NLR is higher in patients with more advanced cancers 10 , and correlates with poor survival in many cancers 14,15. Thus, NLR, a simple and inexpensive biomarker, has been introduced as a significant prognostic factor in many tumour types 3. However, it has not been accepted in many clinical settings since neutrophilia can be also the result of elevated granulopoiesis and, therefore, may not be an adverse sign for cancer progression 3. Another reason is that neutrophilia is associated with poor clinical outcome in all cancers except one, stomach cancer, in which a high NLR is a marker of good prognosis 3,16. However, the evidence for a

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Neutrophil to lymphocyte ratio and breast cancer risk: analysis by subtype and potential interactions

Gago‐Dominguez

Matabuena

Redondo

et al. 2020

Sci Rep

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“…Higher NLR in healthy smokers compared to nonsmokers is in agreement with previous results (Tulgar et al, 2016, Gumus et al, 2018). An elevated NLR has been associated with increased risk for breast cancer (Fang et al, 2018), whereas this is not documented in HNC and needs further studies.…”

Section: Smoking Effect On Biomarkersmentioning

confidence: 92%

Circulating Biomarkers in Patients with Head and Neck Cancer and the Influence of Cigarette Smoking

Andersson

2019

Linköping University Medical Dissertations

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Head and neck cancer (HNC) is a collective name for heterogeneous tumors located in the head and neck regions for which smoking, alcohol and human papillomavirus (HPV) are documented risk factors. The survival of HNC patients has only improved marginally during the last decade. The most important prognostic factors are tumor size, local spread and distant metastases, tumor node metastasis (TNM) staging. Prognostic biomarkers are needed as a complement to TNM staging. The aim for this thesis was to investigate rapid and low cost blood based biomarkers which could indicate the risk of HNC, recurrence of the disease or the survival of HNC patients. Eftersom både rökning och HH-cancer ger upphov till inflammation, undersöktes i studie IV hur dessa var för sig påverkade nivåerna av inflammatoriska biomarkörer. Detta för en bättre förståelse hur immunförsvaret reagerar på rökning och HH-cancer. Jämförelser av inflammatoriska markörer från rökande och icke-rökande patienter, och rökande och ickerökande friska individer genomfördes. Rökning hade störst påverkan på de högre nivåerna av totalt antal vita blodkroppar och signalmolekylerna MCP-1 och IFN-γ. HH-cancer hade störst påverkan på högre nivåerna av neutrofiler, monocyter, kvoten mellan neutrofiler och lymfocyter, CRP, MIP-1b och TNF-α. Uppkomsten av HH-cancer, behandlingsresultat och överlevnad bland patienterna kan antas inte bara bero på tumörens egenskaper, utan även på värdfaktorer hos patienten. Dessa kan vara ärftliga, eller bero på reglering av gener eller tumörens omgivning av t.ex. immunceller och inflammatoriska molekyler och hur dessa samverkar med miljöfaktorer som tobaksrökning. I denna avhandling presenteras biomarkörer som kan bidra med information om risk och prognos för HH-cancer samt hur tobaksrökning påverkar dessa markörer.

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“…Overall, the risk for BC was increased by 49% in adult females with MetS and considered statistically significant and with moderate heterogeneity (RR = 1.49, 95% CI = 1.31-1.70, p < 0.0001, I 2 = 78.8%, random effect model). When 1 study was excluded, I 2 would decrease to 70.5%, with a slight increase in RR (1.56) [22]. Besides, due to using different methods to calculate RR, we divided the studies into cohort and case-control studies.…”

Section: Meta-analysis Of Whole Studiesmentioning

confidence: 99%

The Metabolic Syndrome Is a Risk Factor for Breast Cancer: A Systematic Review and Meta-Analysis

et al. 2020

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Background: The metabolic syndrome (MetS) has been associated with the pathogenesis and prognosis of various malignant tumors. In this systematic review and meta-analysis, we explored the relationship between MetS and breast cancer (BC). Methods: Relevant studies were systematically searched on Ovid MEDLINE, Embase, Cochrane database, and PubMed up to September 16, 2019, using “breast cancer” and “metabolic syndrome” as keywords. Eligible studies with clear definition of MetS, available data, and relationships between MetS and BC were evaluated using a risk ratio (RR) and its 95% confidence interval (CI). Results: Twenty-five studies, including 13 cohort studies and 12 case-control studies, met the inclusion criteria, which assessed a total of 392,583 female participants and 19,628 BC patients. The results revealed a statistically significant increase by 52% of the risk of BC in adult females with MetS (RR = 1.49, 95% CI = 1.31–1.70, p < 0.0001). Postmenopausal MetS patients may have a twofold risk to suffer BC (RR = 2.01, 95% CI = 1.55–2.60, p < 0.001). The risk of BC increased markedly with the number of MetS components: RR = 1.00 for 1 component (p = 0.976), RR = 1.40 for 2 components (p = 0.121), and RR = 1.98 for >3 components (p < 0.001). The risk factors associated with BC were obesity, hypertension, and diabetes (RR = 1.33, 1.19, and 1.30 respectively, all p < 0.001). Conclusions: Our study demonstrated that MetS is highly related with BC. In postmenopausal patients with ≥2 MetS components or a combination of obesity, hypertension, and diabetes, routine BC screening could help to detect BC at an early stage.

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Neutrophil-to-lymphocyte ratio, obesity, and breast cancer risk in Chinese population

Abstract: Supplemental Digital Content is available in the text

Cited by 22 publications

References 41 publications

Neutrophil to lymphocyte ratio and breast cancer risk: analysis by subtype and potential interactions

Neutrophil to lymphocyte ratio and breast cancer risk: analysis by subtype and potential interactions

Circulating Biomarkers in Patients with Head and Neck Cancer and the Influence of Cigarette Smoking

The Metabolic Syndrome Is a Risk Factor for Breast Cancer: A Systematic Review and Meta-Analysis

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