Skip to main content

Advertisement

Log in

Dynamic Neutrophil-to-Lymphocyte Ratio: A Novel Prognosis Measure for Triple-Negative Breast Cancer

  • Translational Research and Biomarkers
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. WHO. https://www.who.int/cancer/prevention/diagnosis-screening/breast-cancer/en/. Accessed 12 May 2019.

  2. 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.

    Article  Google Scholar 

  3. Maegawa RO, Tang SC. Triple-negative breast cancer: unique biology and its management. Cancer Invest. 2010;28(8):878–83.

    Article  CAS  Google Scholar 

  4. 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.

    Article  Google Scholar 

  5. 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.

    PubMed  Google Scholar 

  6. 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.

    Article  Google Scholar 

  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.

    PubMed  PubMed Central  Google Scholar 

  8. 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.

    CAS  PubMed  Google Scholar 

  9. 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.

    Article  CAS  Google Scholar 

  10. 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.

    Article  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. Coffelt SB, Wellenstein MD, de Visser KE. Neutrophils in cancer: neutral no more. Nat Rev Cancer. 2016;16:431–46.

    Article  CAS  Google Scholar 

  13. Farhood B, Najafi M, Mortezaee K. CD8(+) cytotoxic T lymphocytes in cancer immunotherapy: a review. J Cell Physiol. 2019;234:8509–21.

    Article  CAS  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. 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.

    Article  CAS  Google Scholar 

  16. 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.

    Article  Google Scholar 

  17. 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.

    Article  CAS  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. 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.

    Article  Google Scholar 

  20. 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.

    Article  Google Scholar 

  21. 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.

    Article  Google Scholar 

  22. 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.

    Article  Google Scholar 

  23. 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.

    Article  CAS  Google Scholar 

  24. 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.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dan Moldoveanu BSc, MDCM.

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

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-020-08302-2

Navigation