The prognostic value of cancer-associated inflammatory response has been evaluated in various solid malignancies.Derived Neutrophil to lymphocyte ratio (dNLR) is easily accessible and simple prognostic parameter of systemic inflammation associated with breast cancer. Data regarding the dNLR in breast cancer are limited in India. We assessed dNLR as a prognostic marker in patients with non-metastatic breast cancer treated at a tertiary care institute in North India
We retrospectively evaluated the impact of baseline peripheral neutrophil and lymphocyte counts on survival, and investigated the correlation between inflammatory biomarkers and clinico-pathological factors in 497 consecutively treated non-metastatic breast cancer patients between 2011-2014.
Baseline characeristics N = 497
|Age in years||47.7(23-85)|
|Presenting symptoms||Lump > pain > ulcer > bleeding|
|Duration of symptoms in month||7.8 (1-72)|
|Stage||I 18(4%), II 228(46%), III 251(50%)|
|Histology||Ductal 485(97.5%),Lobular 7(1.5%),Metaplastic 5(1%)|
|Receptor Status||ER + /PR + HER2- 209(42%), ER + /PR+ HER2 + ++ 85(17%), ER-PR-HER2 + ++ 71(14%), TNBC 132(27%)|
|Hemoglobin in gm%||11.42(7-16)|
|Total Leukocyte count in mm3||7369 (2450-21900)|
|Absolute Neutrophil Count in mm3||4506 (1100-19800)|
Out of the 497 patients,with a median follow up of 33.5 months, the median disease free survival (DFS) was 33.1 months and 3-year estimated overall survival (OS) was 90%. Receiver operating curve (ROC) analysis showed a cutoff of 2 to be sensitive (60%) and specific (73.7%) with coefficient of 0.76. Pre-therapy high dNLR was independently associated with tendency to poor PFS (HR 0.7, 95%CI 0.4-1.04, p= 0.085) and reduced OS (HR of 3.8, 95% CI = 1.9–7.6, p< 0.001).On multivariate analysis, following factors were associated with inferior survival: elevated dNLR (HR 0.8,p = 0.049, 95% CI1.65-0.04), nodal disease(HR 0.09,p = 0.028, 95%CI 0.009-0.17), presenting duration >6 months (HR 0.04,p-0.014, 95%CI 0.008-0.72) and TNBC subgroups (HR1.5, p
In patients with breast cancer, inflammatory biomarker like elevated dNLR is strongly associated with poor overall survival.It can be utilized as a readily available and reproducible prognostic factor for patients with non-metastatic breast cancer across subgroups and its integration into patient evaluation is relevant in resource limited countries like India.
Clinical trial identification
Legal entity responsible for the study
Ethics Committee, All India Institute of Medical Science
All India Institute of Medical Science, New Delhi
All authors have declared no conflicts of interest.