Dynamic changes of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio predicts breast cancer prognosis

Ju-Yeon Kim,Sang-Ho Jeong,Jae-Myung Kim,Young-Tae Ju,Chi-Young Jeong,Seung-Jin Kwag,Eun Jung Jung,Taejin Park,Ji-Ho Park,Han Shin Lee

doi:10.1186/s12885-020-07700-9

Abstract

BackgroundWe aimed to identify whether neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are more useful predictors after initial intention to treat than at the time of diagnosis.MethodsWe collected the medical data of 533 patients. The results of the peripheral blood sampling before the primary treatments were labeled as initial cohort, and those obtained between 24 and 36 months after initial treatment were defined as the 2nd cohort. Delayed metastasis has been defined as distant metastasis 2 years after treatment, and survival outcome was estimated and compared across groups.ResultsMedian follow-up duration was 74 months (24–162 months), and 53 patients experienced delayed metastasis. In univariate analysis, metastasis-free survival, patient age at diagnosis, tumor size, axillary lymph node metastasis, HER-2 status, initial NLR and PLR, and 2nd NLR and PLR were found to be significantly associated with delayed metastasis. However, in multivariate analysis, only the 2nd NLR and PLR were found to be significantly associated with delayed metastasis, excluding initial NLR and PLR. Metastasis-free survival was analyzed through the pattern changes of NLR or PLR. The results revealed that patients with continued low NLR and PLR values at pre- and post-treatment (low initial values and 2nd values) showed a significantly better prognosis than those with a change in value or continued high NLR and PLR.ConclusionsWe identified that patients with persistent high NLR and PLR after initial treatment have significant worse prognosis in terms of late metastasis. Therefore, these results suggest that NLR and PLR are more useful in predicting prognosis post-treatment.

Highlights

We aimed to identify whether neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are more useful predictors after initial intention to treat than at the time of diagnosis
Diagnosis, tumor size, lymph node metastasis, HER-2 status, initial NLR and PLR, and 2nd NLR and PLR were found to be significantly associated with delayed metastasis
We examined the effects of NLR and PLR changes after initial treatments, wherein the metastasis-free survival (MFS) was analyzed according to the change in NLR or PLR (Fig. 2a and b)

Summary

Introduction

We aimed to identify whether neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are more useful predictors after initial intention to treat than at the time of diagnosis. The leading cause of breast cancer-related deaths is its metastatic spread, the timing and distribution of breast cancer metastases vary considerably. Metastatic spread form a primary breast tumor can occur at an early, pre-symptomatic stage, and disseminated cells often settle in the bone marrow where they can lie dormant for years before becoming clinically evident [4]. A recent meta-analysis demonstrated that an elevated peripheral neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) at the baseline before the first treatment represent poor prognostic factors in breast cancer [5,6,7,8]. Chemotherapy affects various cells, including inflammatory and immune cells, and the subsequent recovery process may vary from patient to patient; these post-treatment changes may affect the expression of disseminated metastatic cells [9]

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