Predictive Value of Pretreatment Peripheral Neutrophil-to-Lymphocyte Ratio for Response to Neoadjuvant Chemotherapy and Breast Cancer Prognosis

Abstract

Background Neutrophil-to-lymphocyte ratio (NLR) is connected with the response to neoadjuvant chemotherapy (NAC) and prognosis. In addition, residual lymph node burden after NAC is likely important for prognosis. However, most studies have focused on the predictive value of NLR for NAC pathological complete response (pCR) rate. The relationship between NLR and post-operative residual lymph node ratio (LNR), and their prognostic values remain to be determined. Methods We retrospectively studied 282 patients with breast cancer who underwent curative surgery after NAC from 2008 to 2018. We collected pretreatment NLR in peripheral blood, the response to NAC, and the amount of axillary lymph nodes (positive and total) from patients who received axillary lymph node dissection (ALND). We followed up all patients from 2 to 116 months, with an average of 63 months. We analyzed the predictive value of pretherapeutic NLR in peripheral blood on the response of NAC, including pCR rate and postoperative LNR. The prognostic value of NLR and LNR was also analyzed. Results A pCR was achieved in 20 (27.0%) of 74 patients with low NLR, and 34 (16.3%) of 208 with high NLR ( P = 0.045). In luminal A and luminal B tumors, patients with high NLR tended to have elevated LNR (LNR>0.5; P =0.041). In Kaplan–Meier analysis, overall survival of patients with low NLR (NLR < 1.8; P = 0.033) was longer than that of patients with high NLR (NLR ≥ 1.8). Moreover, by multivariable analysis, LNR was negatively correlated with overall survival ( P < 0.05) and disease-free survival (DFS) ( P < 0.05). Conclusion pCR rate, post-operative remaining lymph node involvement and overall survival in all patients who received NAC may be predicted by NLR. Low NLR and LNR may suggest favorable outcomes.

The prognostic role of lymph node ratio in breast cancer patients received neoadjuvant chemotherapy: A dose-response meta-analysis

“…Of the 12 studies, 10 studies reported OS and 11 reported DFS. With regard to the study area, four studies were conducted in Chinese ( 10 , 19 , 22 , 27 ), while the remaining nine studies were conducted in non-Chinese countries. The median follow-up ranged from 24 to 87 months.…”

“…Among the 13 eligible studies, 10 studies ( 9 – 11 , 18 , 21 , 23 – 27 ) explored the association between LNR and OS outcomes. Meta-analysis has demonstrated that a significant correlation between higher LNR and shorter OS of breast cancer patients received neoadjuvant chemotherapy (HR: 4.74; 95%CI: 3.36–6.67; P < 0.001) with significant heterogeneity ( I 2 = 57.2%; P = 0.013) ( Figure 2A ).…”

“…Moreover, 11 studies ( 9 , 10 , 18 – 22 , 24 – 27 ) examined the association between higher LNR and shorter OS of breast cancer patients after neoadjuvant chemotherapy. The results showed a significant association (HR: 4.77; 95%CI: 3.69–6.17; P < 0.001) with no heterogeneity ( I 2 = 41.6%; P = 0.072) ( Figure 2B ).…”

“…After the exclusion of duplicate studies and non-relevant studies based on a screening of article titles and abstracts, 38 potentially relevant studies were retrieved for full review. According to the pre-established inclusion and exclusion criteria, 13 studies, involving 4,864 breast cancer patients, were included in this study (9)(10)(11)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). The flow diagram of the literature search was shown in Figure 1.…”

The predictive value of preoperative serum neutrophil-to-lymphocyte ratio and tumor markers for early breast cancer patients: A retrospective study

“…[21] As for those who receiving neoadjuvant chemotherapy, especially with luminal and triple-negative tumors, high pretreatment NLR level usually meant lower pathological complete response rate and worse survival. [22–24] The predictive value of this negative correlation was also expressed in breast cancer patients who underwent local surgical treatment directly. Kim et al [25] found that NLR was associated with poor prognosis among triple-negative breast cancer patients, while the increasement of NLR during treatment compared to the preoperative status may suggest the need for additional treatment besides the routine medical therapy.…”