Highlights
- •An increase in inflammation may lead to worse survival in breast cancer.
- •Inflammatory biomarkers were effective in predicting prognosis for breast cancer.
- •A high platelet–lymphocyte ratio was associated with wore survival.
Abstract
Objective
To analyze the association between four biomarkers and overall survival in patients
with breast cancer (BC).
Methodology
This cohort study had a sample of 2374 women over the age of 18, diagnosed and treated
in a single reference center for BC in Brazil, during the year 2008–2009. The following
pretreatment indices were analyzed: neutrophil–lymphocyte ratio (NLR), a derived neutrophil–lymphocyte
ratio (dNLR), absolute neutrophil count (ANC) and platelet–lymphocyte ratio (PLR).
A descriptive analysis was performed using median (range) and absolute and relative
frequency as categorical variables. Exploratory survival evaluation was performed
using the Kaplan-Meier method and the log-rank test for comparison between survival
curves, with a statistical significance level of 5%. The variables with p < 0.20 were selected for inclusion in a multivariate Cox regression model, considering
as statistically significant p < 0.05.
Results
After adjusting for clinical variables, the biomarkers associated with worse overall
survival were NLR >5 (HR = 1.66 95%CI 1.08–2.55; p = 0.021) and PLR >300 (HR = 1.82 95%CI 1.10–2.99; p = 0.019). When stratified by molecular subtype, the independent markers related to death
were PLR >300 for triple negative (HR 3.27 95%CI 1.38–7.76; p = 0.007); NLR >5 (HR 2.47 95%CI 1.16–5.28; p = 0.019), ANC >7500 (HR 1.84 95%CI 1.17–2.90; p = 0.008) and dNLR >3 (HR 2.45 95%CI 1.29–4.66; p = 0.006) for luminal.
Conclusion
NLR and PLR are independent markers of prognosis in BC. Further studies are needed
in patients with overexpression of HER 2.
Keywords
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References
World Health Organization . Health Statistics and Information Systems: WHO Mortality Database. who.int/healthinfo/mortality_ data/. Accessed July 19, 2016.
- Five-year survival and prognostic factors in a cohort of breast cancer patients treated in Juiz de Fora, Minas Gerais State, Brazil.Cad. Saude Publica. 2009; 25: 2455-2466
- Determinants of advanced stage presentation of breast cancer in 87, 969 Brazilian women.Maturitas. 2015; 82: 365-370
- Role of combined sentinel lymph node biopsy and axillary node sampling in clinically node-negative breast cancer.Indian. J. Surg. 2015; 77: 495-501
- Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients.Ann. Surg. Oncol. 2012; 19: 217-224
- Do the derived neutrophil to lymphocyte ratio and the neutrophil to lymphocyte ratio predict prognosis in breast cancer?.Int. J. Clin. Oncol. 2015; 20: 70-81
- Inflammation and cancer.Nature. 2002; 420: 860-867
- Thesystemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer.Crit.. Rev. Oncol. Hematol. 2013; 88: 218-230
- Neutrophil/lymphocyte ratio has no predictive or prognostic value in breast cancer patients undergoing preoperative systemic therapy.BMC Cancer. 2015; 15: 1027
- Optimization of the systemic inflammation-based glasgow prognostic score: a glasgow inflammation outcome study.Cancer. 2013; 119: 2325-2332
- The elevated preoperative platelet-to-lymphocyte ratio predicts poor prognosis in breast cancer patients.Br. J. Cancer. 2014; 110: 2524-2530
- Clinical significance of pre-operative neutrophil lymphocyte ratio and platelet lymphocyte ratio as prognostic factors for patients with colorectal cancer.Oncol. Lett. 2016; 11: 2241-2248
- Baseline neutrophils and derived neutrophil-to-lymphocyte ratio: prognostic relevance in metastatic melanoma patients receiving ipilimumab.Ann. Oncol. 2016; 27: 732-738
- Systemic inflammation is an independent predictive marker of clinical outcomes in mucosal squamous cell carcinoma of the head and neck in oropharyngeal and non-oropharyngeal patients.BMC Cancer. 2016; 16: 124
- Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study.JAMA. 2006; 295: 2492-2502
- Prognostic role of neutrophil-to-lymphocyte ratio in breast cancer: a systematic review and meta-analysis.Breast Cancer Res. 2017; 19https://doi.org/10.1186/s13058-016-0794-1
- The neutrophil lymphocyte ratio is associated with breast cancer prognosis: an updated systematic review and meta-analysis.Onco Targets Ther. 2016; 9 (Review): 5567-5575https://doi.org/10.2147/OTT.S108419
- Prognostic value of neutrophil-to-lymphocyte ratio in breast cancer.FEBS Open Biol. 2015; 5: 502-507
- Usefulness of pretreatment neutrophil to lymphocyte ratio in predicting disease-specific survival in breast cancer patients.J. Breast Cancer. 2013; 16: 55-59https://doi.org/10.4048/jbc.2013.16.1.55
- Role of blood platelets in infection and inflammation.J. Interferon Cytokine Res. 2002; 22: 913-922
- Pretreatment neutrophil/lymphocyte ratio is superior to platelet/lymphocyte ratio as a predictor of long-term mortality in breast cancer patients.Med. Oncol. 2013; 30: 432
- Elevated preoperative neutrophil-to-lymphocyte ratio predicts poor disease-free survival in Chinese women with breast cancer.Tumour Biol. 2016; 37: 4135-4142https://doi.org/10.1007/s13277-015-4233-1
- Usefulness of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in hormone-receptor-negative breast cancer.Onco Targets Ther. 2016; 9: 4653-4660https://doi.org/10.2147/OTT.S106017
- The peripheral blood neutrophil-to-lymphocyte ratio is superior to the lymphocyte- to-monocyte ratio for predicting the long-term survival of triple- negative breast cancer patients.PLoS One. 2015; 18: e0143061https://doi.org/10.1371/journal.pone.0143061
- Pre-treatment neutrophil to lymphocyte ratio may be a useful tool in predicting survival in early triple negative breast cancer patients.BMC Cancer. 2015; 28: 195https://doi.org/10.1186/s12885-015-1204-2
- Utility of pre-treatment neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as prognostic factors in breast cancer.Br. J. Cancer. 2015; 113: 150-158https://doi.org/10.1038/bjc.2015.183
- Pre-treatment elevated platelet count associates with HER2 overexpression and prognosis in patients with Breast cancer.Asian Pac. J. Cancer Prev. 2015; 16: 5537-5540
- Neutrophil/lymphocyte ratio in complete blood count as a mortality predictor in breast cancer.Rev. Med. Chil. 2016; 144: 691-696https://doi.org/10.4067/S0034-98872016000600001
Article info
Publication history
Published online: April 23, 2017
Accepted:
April 18,
2017
Received:
December 7,
2016
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
