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. 2015 Mar 28:15:195.
doi: 10.1186/s12885-015-1204-2.

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

Mirco Pistelli  1 , Mariagrazia De Lisa  2 , Zelmira Ballatore  3 , Miriam Caramanti  4 , Alessandra Pagliacci  5 , Nicola Battelli  6 , Francesca Ridolfi  7 , Matteo Santoni  8 , Elena Maccaroni  9 , Raffaella Bracci  10 , Alfredo Santinelli  11 , Tommasina Biscotti  12 , Rossana Berardi  13 , Stefano Cascinu  14
Affiliations

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

Mirco Pistelli et al. BMC Cancer. .

Abstract

Background: There 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).

Methods: We 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.

Results: A 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.

Conclusion: Our 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.

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Figures

Figure 1
Figure 1
Receiver operating characteristics (ROC) analysis based on NLR for DFS. In this model sensitivity was 84.6% (95% CI 54.5 – 97.6) and specificity was 57.1% (95% CI 45.4–68.4). AUC was 0.71, p = 0.01.
Figure 2
Figure 2
Receiver operating characteristics (ROC) analysis based on NLR for OS. In this model sensitivity was 75% (95% CI 35.0 – 96.1) and specificity was 73.1% (95% CI 62.2–82.4). AUC was 0.73, p = 0.02.
Figure 3
Figure 3
We identified 126 patients who were diagnosed and completed the treatment of triple-negative breast cancer; 90 patients were eligible for analysis. ACE = Angiotensin-Converting Enzyme inhibitors.
Figure 4
Figure 4
Distribution of the baseline NLR in the peripheral blood of 90 patients with triple negative breast cancer (TNBC).
Figure 5
Figure 5
DFS of patients with early TNBC based on NLR (p = 0.002).
Figure 6
Figure 6
OS of patients with early TNBC based on NLR (p = 0.009).
See this image and copyright information in PMC

References

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