Prognostic value of the neutrophil-lymphocyte, platelet-lymphocyte and monocyte-lymphocyte ratio in breast cancer patients

Abstract

The aim of the present study was to assess the blood the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR) as prognostic factors in breast cancer (BC) patients. A retrospective analysis of 436 BC patients who were treated at COI (Gliwice, Poland) between January 2005 and June 2018 was performed. The prognostic value [overall survival (OS)] of the pre-treatment PLR, NLR and MLR was assessed by univariate and multivariate analysis. The 5-year OS was lower in the NLR >2.65 compared with that in the NLR≤2.65 group (82.5 vs. 89.6%; P=0.053), and significantly lower in the subgroup of triple-negative breast cancer (TNBC; 70.3 vs. 89.3%; P=0.034) and in patients whose tumors had an estrogen receptor-negative [ER(-)] status (66.6 vs. 83.6%; P=0.018). The 5-year OS was lower in patients with PLR >190.9 compared with that in the PLR≤190.9 group (78.7 vs. 89.4%; P=0.020). A poor OS rate associated with an elevated PLR was also observed in the subgroups with TNBC (68.2 vs. 88.5%; P=0.032) and with ER(-) status tumors (57.7 vs. 83.6%, P=0.002). An elevated MLR (>0.28) was not associated with OS time (P=0.830). Multivariate analysis revealed that the NLR and PLR were insignificant negative prognostic factors, except for the subgroup of patients with ER(-) tumors, where an elevated NLR [hazard ratio (HR)=2.40; 95% confidence interval (CI): 1.20-4.80; P=0.013] and a higher PLR (HR=2.51; 95%CI: 1.23-5.14; P=0.012) were independent prognostic factors for poor OS together with lymph node metastasis ((HR=5.47; 95%CI: 2.46-12.15; P=0.0001 and HR=4.82; 95% CI: 2.15-10.78; P=0.0001), respectively. The present results revealed that an elevated NLR (>2.65) and PLR (>190.9) are associated with poor OS in BC patients. In the ER(-) subgroup of patients, an elevated NLR and PLR were significant independent prognostic factors. However, the MLR did not affect OS.

Keywords: breast cancer; monocyte-lymphocyte ratio; neutrophil-lymphocyte ratio; overall survival; platelet-lymphocyte ratio.

Figure 1.

Prognostic value of an elevated NLR in breast cancer patients. (A) All patients (P=0.053), (B) patients with triple negative BC (P=0.034), (C) patients with ER-negative (P=0.018), (D) patients with tumor grade G3 (P=0.020), (E) patients with nodal status positive (P=0.118) and (F) patients with HER2-positive (P=0.167). NLR, neutrophil-lymphocyte ratio; BC, breast cancer; ER, estrogen receptor.

Figure 2.

Prognostic value of an elevated PLR in breast cancer patients. (A) All patients (P=0.020), (B) patients with triple negative BC (P=0.032), (C) patients with ER-negative (P=0.002), (D) patients with tumor grade G3 (P=0.002), (E) patients with nodal status positive (P=0.085) and (F) patients with HER2-positive (P=0.061). PLR, platelet-lymphocyte ratio; BC, breast cancer; ER, estrogen receptor.

Figure 3.

Prognostic value of an elevated MLR in breast cancer patients. (A) All patients (P=0.830), (B) patients with triple negative BC (P=0.219), (C) patients with ER-negative (P=0.728), (D) patients with tumor grade G3 (P=0.995), (E) patients with nodal status positive (P=0.058) and (F) patients with HER2-positive (P=0.474). MLR, monocyte-lymphocyte ratio; BC, breast cancer; ER, estrogen receptor.