Neutrophil-to-lymphocyte ratio (NLR), tumor-infiltrating lymphocyte (TIL) and programmed death-ligand 1 (PD-L1) expression is known to be associated with immunogenicity and prognosis of breast cancer. We analyzed baseline NLR and its clinical association in triple-negative breast cancer (TNBC). The changes of NLR, TIL and PD-L1 during neoadjuvant chemotherapy (NAC) and their association to recurrence was analyzed.
Between Jan 2008 to Dec 2015, 358 TNBC patients were analyzed. NLR was based on initial complete blood count (CBC). Fifty paired NLR (initial diagnosis, after completion of NAC) and 34 paired tissues (initial diagnosis, surgical specimen) were collected. The changes of TIL, CD4, CD8, forkhead box P3 (FOXP3) and PD-L1 expression were assessed with immunohistochemical stain. The relationship of prior markers and tumor recurrence was analyzed.
Low NLR (NLR≤3.16) was associated to superior survival [overall survival; 41.83 vs. 36.5 months, P = 0.002; disease-free survival (DFS) 37.85 vs. 32.14 months, P = 0.032]. After NAC, patients with radical NLR changes (NLR change < -30% or > 100%) showed inferior DFS (38.37 vs. 22.37 months, P = 0.015). Same or increased TIL after NAC showed trends for superior DFS (80.0 vs. 46.0 months, P = 0.366). Positive PD-L1 (≥1%) in tumor cells at baseline was associated to superior DFS (97.45 vs. 33.02 months, P = 0.031), and positive tumor PD-L1 at post-NAC tissues showed trends for superior DFS (86.43 vs. 38.76 months, P = 0.056).
In TNBC patients, low NLR might be associated with superior survival. Modest changes of NLR or increased TIL after NAC may reflect good prognosis. Positive tumor PD-L1 was associated with superior DFS in our study.
Clinical trial identification
Legal entity responsible for the study
Seoul St. Mary's Hospital, Incheon St. Mary's Hospital.
Has not received any funding.
All authors have declared no conflicts of interest.