Tumors are closely linked with systemic inflammation, of which neutrophil-to-lymphocyte ratio (NLR) represents a simple and inexpensive tool of evaluation. Previous data suggested that a high NLR is associated with poor prognosis in several tumors, including breast cancer (BC). However, few studies involved patients (pts) with metastatic breast cancer (mBC).
We retrospectively analyzed clinico-pathological features and treatment outcome of 595 consecutive mBC pts treated at the Department of Oncology of Udine, Italy, between 2004 and 2014. NLR was calculated from the blood count performed before first line therapy start. Differences in NLR according to clinico-pathological characteristics were investigated through chi-square test. Cox regression was used to determine the prognostic impact of NLR.
A statistically significant higher NLR was found in pts whose tumor had the following features: high grade (P = 0.009), ductal isotype (P = 0.02), ER negativity (P = 0.003), PgR negativity (P = 0.0001), high Ki-67 (P = 0.03). There were no statistical differences in NLR between HER2-positive and HER2-negative BC (P = 0.33). Among subtypes, triple-negative BC were associated with higher NLR, while luminal HER2+ BC with lower NLR (P = 0.004). No statistical differences in NLR were found according to visceral disease (P = 0.13) nor according with bone-only disease (P = 0.24). At univariate analysis, a NLR ≥2.64 was associated with worse progression-free survival after first line therapy (HR 1.41, 95%CI 1.11-1.79, P = 0.005) and with worse overall survival (HR 1.76, 95%CI 1.32-2.36, P
High NLR was associated with pathological features of BC, but did not represent an independent prognostic factor at multivariate analysis. Further investigation is warranted to identify the appropriate cut-off value of NLR and the BC subtypes in which its prognostic role could be more useful.
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Legal entity responsible for the study
University of Udine
All authors have declared no conflicts of interest.