Abstract
Background
The neutrophil-to-lymphocyte ratio (NLR) is a measure of systemic inflammation and a prognostic factor for multiple malignancies. This study assesses the value of the NLR as an independent prognostic marker in triple-negative breast cancer (TNBC) and explores the association between dynamic NLR changes and patient outcomes.
Methods
The study retrospectively analyzed a prospectively maintained database including patients 18 to 80 years old with TNBC treated at the authors’ institution between 2006 to 2016. Clinical and demographic data were collected, including blood test results and treatments received. Age at diagnosis, stage of disease, and NLR scores were tested for association with overall and disease-free survival in uni- and multivariate Cox models.
Results
The inclusion criteria were met by 329 women with a median age of 58. Most of the patients had early-stage disease (30.1% with stage 1 and 47% with stage 2 malignancy). An NLR higher than 2.84 at diagnosis was associated with decreased overall survival (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.023–3.176), whereas an NLR higher than 7.82 at any time during the follow-up period was a strong predictor of 5-year mortality (HR, 10.76; 95% CI, 4.193–26.58), independent of age or stage of disease. Patients who experienced recurrence had a higher NLR than their counterparts during the 6 months before recurrence. The NLR also significantly rose during the final 18 months of life (p < 0.01).
Conclusion
The NLR is an important prognostic marker in TNBC, both at diagnosis and during the course of the disease. Moreover, dynamic changes in NLR strongly correlate with disease recurrence and the time of death.
Similar content being viewed by others
References
WHO. https://www.who.int/cancer/prevention/diagnosis-screening/breast-cancer/en/. Accessed 12 May 2019.
Penault-Llorca F, Viale G. Pathological and molecular diagnosis of triple-negative breast cancer: a clinical perspective. Ann Oncol. 2012;23(Suppl 6):vi19–vi22.
Maegawa RO, Tang SC. Triple-negative breast cancer: unique biology and its management. Cancer Invest. 2010;28(8):878–83.
Dent R, Trudeau M, Pritchard KI, et al. Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res. 2007;13(15 Pt 1):4429–34.
Bozkurt O, Karaca H, Berk V, et al. Predicting the role of the pretreatment neutrophil-to-lymphocyte ratio in the survival of early triple-negative breast cancer patients. J BUON. 2015;20:1432–9.
Haffty BG, Yang Q, Reiss M, et al. Locoregional relapse and distant metastasis in conservatively managed triple negative early-stage breast cancer. J Clin Oncol. 2006;24:5652–7.
Zhang J, Wang Y, Yin Q, Zhang W, Zhang T, Niu Y. An associated classification of triple-negative breast cancer: the risk of relapse and the response to chemotherapy. Int J Clin Exp Pathol. 2013;6:1380–91.
Zahorec R. Ratio of neutrophil to lymphocyte counts: rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102:5–14.
Wang X, Zhang G, Jiang X, Zhu H, Lu Z, Xu L. Neutrophil-to-lymphocyte ratio in relation to risk of all-cause mortality and cardiovascular events among patients undergoing angiography or cardiac revascularization: a meta-analysis of observational studies. Atherosclerosis. 2014;234:206–13.
Yu S, Arima H, Bertmar C, Clarke S, Herkes G, Krause M. Neutrophil-to-lymphocyte ratio and early clinical outcomes in patients with acute ischemic stroke. J Neurol Sci. 2018;387:115–8.
Templeton AJ, McNamara MG, Seruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106:dju124.
Coffelt SB, Wellenstein MD, de Visser KE. Neutrophils in cancer: neutral no more. Nat Rev Cancer. 2016;16:431–46.
Farhood B, Najafi M, Mortezaee K. CD8(+) cytotoxic T lymphocytes in cancer immunotherapy: a review. J Cell Physiol. 2019;234:8509–21.
Liu X, Qu JK, Zhang J, et al. Prognostic role of pretreatment neutrophil to lymphocyte ratio in breast cancer patients: a meta-analysis. Med Baltim. 2017;96:e8101.
Jiang Y, Xu H, Jiang H, Ding S, Zheng T. Pretreatment neutrophil-lymphocyte count ratio may associate with gastric cancer presence. Cancer Biomark. 2016;16:523–8.
Minardi D, Scartozzi M, Montesi L, et al. Neutrophil-to-lymphocyte ratio may be associated with the outcome in patients with prostate cancer. Springerplus. 2015;4:255.
Hong X, Cui B, Wang M, Yang Z, Wang L, Xu Q. Systemic Immune-Inflammation Index, based on platelet counts and neutrophil-lymphocyte ratio, is useful for predicting prognosis in small cell lung cancer. Tohoku J Exp Med. 2015;236:297–304.
Pistelli M, De Lisa M, Ballatore Z, et al. Pretreatment neutrophil-to-lymphocyte ratio may be a useful tool in predicting survival in early triple-negative breast cancer patients. BMC Cancer. 2015;15:195.
Hong J, Mao Y, Chen X, et al. Elevated preoperative neutrophil-to-lymphocyte ratio predicts poor disease-free survival in Chinese women with breast cancer. Tumour Biol. 2016;37:4135–42.
Li Z, Zhao R, Cui Y, Zhou Y, Wu X. The dynamic change of neutrophil-to-lymphocyte ratio can predict clinical outcome in stage I–III colon cancer. Sci Rep. 2018;8:9453.
Peng W, Li C, Wen TF, et al. Neutrophil-to-lymphocyte ratio changes predict small hepatocellular carcinoma survival. J Surg Res. 2014;192:402–8.
Cho KM, Park H, Oh DY, et al. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and their dynamic changes during chemotherapy is useful to predict a more accurate prognosis of advanced biliary tract cancer. Oncotarget. 2017;8:2329–41.
Dan J, Zhang Y, Peng Z, et al. Postoperative neutrophil-to-lymphocyte ratio change predicts survival of patients with small hepatocellular carcinoma undergoing radiofrequency ablation. PLoS ONE. 2013;8:e58184.
Iwase T, Sangai T, Sakakibara M, et al. An increased neutrophil-to-lymphocyte ratio predicts poorer survival following recurrence for patients with breast cancer. Mol Clin Oncol. 2017;6:266–70.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
The authors have no conflicts of interest to declare.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Moldoveanu, D., Pravongviengkham, V., Best, G. et al. Dynamic Neutrophil-to-Lymphocyte Ratio: A Novel Prognosis Measure for Triple-Negative Breast Cancer. Ann Surg Oncol 27, 4028–4034 (2020). https://doi.org/10.1245/s10434-020-08302-2
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-020-08302-2