High neutrophil to lymphocyte ratio may reflect the key role of systemic inflammation in enhancing angiogenesis, tumor growth and development of metastasis The role of lymphocytes cells in cancer control is exemplified by the strong association between high densities of tumor-infiltrating lymphocytes and better responses to both, cytotoxic treatments and outcome in patients with breast cancer.
A total number of files reviewed is 1167 files and a total of 102 breast cancer patients included in this study with histologically proven early stage (T1–2, N0–1, non-metastatic) breast cancer treated in Babylon Oncology Center from January 2009 to September 2014 were considered for this retrospective study. The following data were collected from patient file: age, date of diagnosis, date of recurrence and/or metastasis, follow up period, histological tumor type, tumor size, tumor-node-metastasis stage, expression of estrogen and/or progesterone receptor, HER-2-neu status, metastasis site and with inclusion criteria of Tumor stage up to stage IIA (T1-T2, N0/ T1, N1), follow up for at least 36 months and pre-treatment CBC with differential count.
With mean age of 50.4 ± 11.7 years and minimum follow up 40 months, the overall median DFS was 62 months with 5 – years DFS of 52.5%, stage N0 show significant better DFS compared to stage N1 (P value 0.004), also patients with positive hormonal status show significant better DFS compared to negative hormonal status (P value 0.029), NLR has significant outcome on DFS when increased the ratio leading to declining in DFS (P value 0.006), NLR fair specificity (76.9%) with lower sensitivity (62.2%), with optimal cut point of > 2.194 to predict DFS with better DFS about 16 months (P value 0.0004), and Hazard Ration is 2.5 (P value 0.007), in univariate analysis the significant Hazard Ratio are NLR, N staging and Hormonal status while in multivariate analysis shows only NLR Hazard Ratio with (0.012 P value). In our study PLR neither sensitive nor specific with non-significant P value so it will not be consider as a prognostic index.
Elevated NLR is strongly associated with poor disease free survival of breast cancer patients.
Clinical trial identification
Legal entity responsible for the study
Iraqi Board for Medical Specialities.
Has not received any funding.
All authors have declared no conflicts of interest.