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

Abstract

Purpose: The peripheral hematologic parameters of patients can be prognostic for many malignant tumors, including breast cancer, although their value has not been investigated among the different molecular subtypes of breast cancer. The purpose of this study was to examine the prognostic significance of the neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte-to-monocyte ratio (LMR) in different molecular subtypes of breast cancer.

Methods: A retrospective cohort of 1570 operable breast cancer patients was recruited between January 2000 and December 2010. The counts of peripheral neutrophils, lymphocytes, monocytes and platelets were collected and applied to calculate the NLR and the LMR. Univariate and multivariate Cox proportional hazard analyses were used to assess the relationship of the NLR and the LMR with disease-free survival (DFS) and overall survival (OS) in all patients and triple negative breast cancer (TNBC) patients.

Results: Univariate analysis revealed that lower NLR (≤2.0) and higher LMR (>4.8) were significantly associated with superior DFS in all patients (NLR, P = 0.005; LMR, P = 0.041) and in TNBC patients (NLR, p = 0.007; LMR, P = 0.011). However, multivariate analysis revealed that only lower NLR was a significant independent predictor of superior DFS and OS in all breast cancer patients (DFS, HR = 1.50 95% CI: 1.14-1.97, P = 0.004; OS, HR = 1.63, 95% CI: 1.07-2.49, P = 0.022) and in TNBC patients (DFS, HR = 2.58, 95% CI: 1.23-5.42, P = 0.012; OS, HR = 3.05, 95% CI: 1.08-8.61, P = 0.035). Both univariate and multivariate analysis revealed that neither the NLR nor the LMR significantly predicted DFS and OS among the patients with other molecular subtypes of breast cancer.

Conclusions: A higher pretreatment peripheral NLR significantly and independently indicated a poor prognosis for breast cancer and TNBC, and this measurement exhibited greater prognostic value than a lower LMR. The NLR was not a prognostic factor for other breast cancer subtypes.

Fig 1. Prognostic value of NLR for breast cancer patients.

Kaplan-Meier curves of DFS for all patients (A), DFS for the patients with ER-positive and/or PR-positive/HER2-negative disease (B), DFS for the patients with HER2-positive disease (C), DFS for the patients with ER-negative/PR-negative/HER2-negative disease (D), OS for all patients (E), OS for the patients with ER-positive and/or PR-positive/HER2-negative disease (F), OS for the patients with HER2-positive disease (G), and OS for the patients with ER-negative/PR-negative/HER2-negative disease (H).

Fig 2. Prognostic value of the LMR for breast cancer patients.

Kaplan-Meier curves of DFS for all patients (A), DFS for the patients with ER-positive and/or PR-positive/HER2-negative disease (B), DFS for the patients with HER2-positive disease (C), DFS for the patients with ER-negative/PR-negative/HER2-negative disease (D), OS for all patients (E), OS for the patients with ER-positive and/or PR-positive/HER2-negative disease (F), OS for the patients with HER2-positive disease (G), and OS for the patients with ER-negative/PR-negative/HER2-negative disease (H).