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. 2021 Feb;16(1):43-49.
doi: 10.1159/000506463. Epub 2020 Apr 14.

The Usefulness of the Pretreatment Neutrophil/Lymphocyte Ratio as a Predictor of the 5-Year Survival in Stage 1-3 Triple Negative Breast Cancer Patients

Basem Azab  1 , Julia R Amundson  2 , Alessia Cioci  3 , Heather Stuart  4 , Danny Yakoub  5 , Eli Avisar  3 , Fredrick Moffat  3 , Alan S Livingstone  3 , Dido Franceschi  3
Affiliations

The Usefulness of the Pretreatment Neutrophil/Lymphocyte Ratio as a Predictor of the 5-Year Survival in Stage 1-3 Triple Negative Breast Cancer Patients

Basem Azab et al. Breast Care (Basel). 2021 Feb.

Abstract

Background: We have previously shown that the neutrophil/lymphocyte ratio (NLR) is a predictor of survival among breast cancer patients. The aim of this study was to determine the predictive value of NLR among different nodal and chemotherapy subgroups of triple negative breast cancer (TNBC).

Methods: Patients with stage 1-3 TNBC who underwent treatment from 2007 to 2014 and had blood counts prior to treatments were included. Patients were categorized into high (≥2) and low (<2) NLR groups. Primary outcomes were overall survival (OS) and disease-free survival (DFS).

Results: The average follow-up time was 54 months. The high NLR group had worse OS (HR 2.8, CI 1.3-5.9, p < 0.001) and DFS (HR 2.3, CI 1.2-4.2, p < 0.001) than the low NLR group. After adjusting for confounding variables, high NLR was an independent prognostic factor for both OS (HR 5.5, CI 2.2-13.7, p < 0.0001) and DFS (HR 5.2, CI 2.3-11.6, p < 0.0001). Categorization of TNBC patients by NLR (high vs. low) and nodal status (positive vs. negative) resulted in four groups with significantly different OS and DFS (log rank p < 0.0001). Significant improvements in OS (p < 0.001) and DFS (p < 0.001) were observed for patients who received chemotherapy and had high NLR but not for patients with low NLR (p = 0.65 and p = 0.07, respectively).

Conclusion: High pretreatment NLR is an independent predictor of poor OS and DFS among TNBC patients. Combining NLR and pN provides better risk stratification for TNBC patients. Chemotherapy appears to be beneficial only in patients with high NLR. Larger prospective studies are needed to validate these findings.

Keywords: Mortality; Neutrophil/lymphocyte ratio; Triple negative breast cancer.

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Conflict of interest statement

There is no relationship with any industry to disclose. The authors report no potential conflicts of interest.

Figures

Fig. 1
Fig. 1
a The 5-year OS and DFS statuses according to the pretreatment NLR among pN0 TNBC patients. b The 5-year OS and DFS statuses among TNBC patients according to their chemotherapy statuses in low and high NLR subgroups.
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