Predictive value of neutrophil-to-lymphocyte ratio on pathological complete response in triple negative breast cancer.

Abstract

e12012 Background: Immune response in Triple Negative Breast Cancer (TNBC) plays a critical role in pathological complete response (pCR) after neoadjuvant chemotherapy (NAC). Therefore, neutrophil to lymphocyte ratio (NLR) could be an interesting biomarker to evaluate systemic inflammation in TNBC. Our aim was to evaluate the effect of NLR, also progression free survival (PFS) and overall survival (OS) as secondary objectives. Methods: We reviewed 338 medical records of II-III CS TNBC patients treated with NAC, in the 2000-2014 period, at Instituto Nacional de Enfermedades Neoplasicas. Patients were grouped in NLR < 3 and ≥3. Survival differences were assessed by log-rank test in the univariate analysis and prognostic factors were then investigated by Cox regression analysis. Results: Mean age was 47y [range:24-79], 54% were premenopausal, 90.9% had clinical T3-T4 tumor and 80.5% clinical nodal involvement. There were 44 and 294 pts with II and III CS, respectively. From 338 patients, 259 had NLR < 3 and 79, ≥3. No significant clinical differences were noted between these groups, except a higher mean BMI among patients with NLR < 3 (28 vs 26Kg/m2, p = 0.01). pCR rate was higher in NLR < 3 patients (22% vs 15.2%, p < 0.001) and partial response was reached on 70.7% and 62% of pts with NLR < 3 and ≥3, respectively. At 5 year median follow-up, 5-year DFS was higher among patients with NLR < 3 (47 vs 34%, HR = 0.69, 95%CI: 0.50-0.95, p = 0.02) and so was 5-year OS (55 vs 40%, HR: 0.61, CI95%: 0.43-0.85, p = 0.004). At multivariate analysis, premenopausal status, non-pCR and nodal involvement were associated with worse DFS. Otherwise, NLR < 3 (HR: 0.61, 95%CI: 0.43-0.86, p = 0.005) and pCR were predictors of better OS, nonetheless nodal involvement had negative impact on OS. Conclusions: NLR is a valuable predictive biomarker of pCR and OS in TNBC patients. We report less pCR rates due to higher stages among peruvian population.

Neutrophil/lymphocyte ratio and overall survival in patients with breast cancer: a cohort study in a Latin-American hospital

“…This rate is defined as the division of absolute neutrophil count over absolute lymphocyte count. The rate was categorized as low if NLR<3 and high if NLR≥3, according to Enríquez et al, 10 since said cut-off point predicted OS and complete pathological response in this study, in a very similar context. These measurements were made in the same way in the exposed and unexposed group.…”

“…Some research in Latin America has studied the NLR as an adverse prognostic factor in patients with different types of cancer, with few related to breast cancer. 10,11 However, these studies were conducted only in patients with triple-negative breast cancer, which, although more aggressive, is not the most frequent of those presented in the region; therefore, it is necessary to perform studies including other cancer subtypes such as Luminal A, Luminal B or HER 2. In this sense, the general objetive of this study is to determine the association between NLR and OS in patients with breast cancer in the gynecology department of Hospital Nacional Hipólito Unanue (HNHU), Lima, Peru between 2012 and 2014.…”