Pre-treatment neutrophil to lymphocyte ratio may be a useful tool in predicting survival in early triple negative breast cancer patients

Abstract

BackgroundThere is a growing body of evidence that immune response plays a large role in cancer outcome. The neutrophil to lymphocyte ratio (NLR) has been used as a simple parameter of systemic inflammation in several tumors. The purpose was to investigate the association between pre-treatment NLR, disease-free survival and overall survival in patients with early triple negative breast cancer (TNBC).MethodsWe reviewed the records of patients with stage I-III TNBC at our Institution from 2006 to 2012. The association between pre-treatment NLR and survival was analyzed. The difference among variables was calculated by chi-square test. DFS and OS were estimated using Kaplan-Meier method. Cox analysis was performed to analyze clinical parameters for their prognostic relevance.ResultsA total of 90 patients were eligible. There was no significant correlation among pre-treatment NLR and various clinical pathological factors. Patients with NLR higher than 3 showed significantly lower DFS (p = 0.002) and OS (p = 0.009) than patients with NLR equal or lower than 3. The Cox proportional multivariate hazard model revealed that higher pre-treatment NLR was independently correlated with poor DFS and OS, with hazard ratio 5.15 (95% confidence interval [CI] 1.11-23.88, p = 0.03) and 6.16 (95% CI 1.54-24.66, p = 0.01) respectively.ConclusionOur study suggests that pre-treatment NLR may be associated with DFS and OS patients with early TNBC. Further validation and a feasibility study are required before it can be considered for clinical use.

C‑reactive protein/albumin and neutrophil/lymphocyte ratios and their combination predict overall survival in patients with gastric cancer

“…Multiple studies have confirmed that NLR is an easily available and reliable marker, which is associated with poor prognosis in various malignancies (19)(20)(21)(22)(23). The present study revealed that NLR was significantly associated with TNM stage, tumor invasion, tumor size, distant metastasis and poor prognosis, which was consistent with a previous study (43).…”

“…NLR represents the balance between inflammatory activation and regulatory factors (19). Increased NLR may also serve as an independent prognostic risk factor in multiple types of cancer, including lung (20) and breast cancer (21), renal cell carcinoma (22), and ovarian cancer (23 Statistical analysis. Data are expressed as the mean ± standard deviation.…”

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

“…44 In a recently published Italian trial, in which the significance of NLR was explored in 90 triple negative patients with breast cancer by means of ROC analysis, NLR >3 was associated with worse survival. 45 Finally, in two cohorts of 363 and 147 patients, respectively, treated with conservative breast surgery (and intraoperative non-steroidal antiinflammatory drugs) at Louvain University, disease-free survival and overall survival were shown to be significantly correlated with high NLR (>3.3), as calculated by ROC analysis. 46 It should be noted that the NLR cut-off value selected by ROC curve analysis in our study (1.97) is lower than that used in the abovementioned papers.…”

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

“…In those studies, a high nlr was associated with poor survival probability. In breast cancer, the role of the nlr as a prognosticator has been evaluated in various settings 17,19,32,33 . Azab et al 17 were the first to report that the nlr is an independent predictor for both short-and long-term mortality, with a higher nlr being associated with worse outcomes.…”