Prognostic value of systemic inflammatory markers and development of a nomogram in breast cancer

Abstract

Systemic inflammatory markers derived from peripheral blood cell, such as the neutrophil-lymphocyte ratio (NLR), derived neutrophil-lymphocyte ratio (dNLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR), have been demonstrated as prognostic markers in several types of malignancy. Here, we investigated and compared the association between systemic inflammatory markers and survival and developed a prognostic nomogram in breast cancer patients. We reviewed the clinical and pathological records of 661 patients diagnosed with invasive breast carcinoma between 1993 and 2011. The NLR, dNLR, PLR and LMR in the immediate preoperative period were assessed. We analyzed the relationship between these inflammatory markers and clinicopathologic variables, disease-specific survival (DSS), and disease-free survival (DFS) in patients. A nomogram was developed to predict 3- and 5-year DSS for breast cancer. In the univariate analysis, high NLR, dNLR, PLR and low LMR were all significantly associated with poor DSS and DFS. In the multivariate analysis, only the PLR (HR 3.226, 95% CI 1.768–5.885 for DSS and HR 1.824, 95% CI 1.824–6.321 for DFS) was still identified as an independent predictor of outcomes. A subgroup analysis revealed that the PLR was the sole independent marker predicting poor DSS in patients with lymph node metastasis (HR 2.294, 95% CI 1.102–4.777) and with luminal subtype (HR 4.039, 95% CI 1.905–8.562). The proposed nomogram, which includes the PLR, shows good accuracy in predicting DSS with a concordance index of 0.82. PLR is an indicator of systemic inflammation as a part of the host immune response. As an independent prognostic factor, an elevated preoperative PLR is superior to the NLR, dNLR, and LMR in predicting clinical outcomes in patients with breast cancer. Moreover, the nomogram incorporating the PLR could accurately predict individualized survival probability in breast cancer.

Preoperative neutrophil‐to‐lymphocyte ratio predicts malignancy and recurrence‐free survival of solid pseudopapillary tumor of the pancreas

“…The reason may be that SPTP involving this location is more likely to result in sinistral portal hypertension presenting with a decreased platelet count . Several studies have shown that elevated PLR was superior to NLR as a prognostic indicator for many malignancies such as breast cancer, soft‐tissue sarcoma, and colorectal carcinoma . We were unable to demonstrate the value of PLR in predicting clinical outcomes of SPTP, probably due to the small sample size.…”

“…28 Several studies have shown that elevated PLR was superior to NLR as a prognostic indicator for many malignancies such as breast cancer, soft-tissue sarcoma, and colorectal carcinoma. [29][30][31] We were unable to demonstrate the value of PLR in predicting clinical outcomes of SPTP, probably due to the small sample size. Indeed, PLR has not been shown as a predictive marker for IPMN-associated malignancy either.…”

Periodontal disease, sleep duration, and white blood cell markers in the 2009 to 2014 National Health and Nutrition Examination Surveys

“…Elevated levels of inflammatory biomarkers (e.g., C-reactive protein [CRP], interleukin-6 [IL-6], interleukin-8 , interleukin-10 [IL-10], tumor necrosis factor-alpha [TNF-], and white blood cells [WBCs]) are associated with risk and prognosis of chronic conditions, including cardiovascular disease [1][2][3] and cancer. [4][5][6][7][8][9] Recent studies have also suggested that periodontal disease [10][11][12] and sleep behavior 13,14 may increase the risk of chronic disease onset and progression through inflammatory mechanisms, and may be linked to each other. [15][16][17] Current evidence linking periodontal disease 18,19 and sleep behavior [20][21][22] to systemic inflammation focused primarily on CRP with limited evidence for WBCs or their products as inflammatory biomarkers.…”

The Value of Prognostic Nutritional Index (PNI) in Predicting Survival and Guiding Radiotherapy of Patients With T1-2N1 Breast Cancer

“…The PNI was calculated (12) as 10 × serum albumin (g/dl) + 0.005 × total lymphocyte count (per mm 3 ). The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR) were calculated (15) as follows: NLR = N/L; PLR = P/L; and MLR = M/L, where P, N, M, and L represent the platelet (10 9 /L), neutrophil (10 9 /L), monocyte (10 9 /L), and lymphocyte (10 9 /L) counts, respectively.…”