Neutrophil-lymphocyte Ratio as Independent Prognostic Factor among Breast Cancer Patients in a Tertiary Care Hospital, Kolkata, India

Abstract

Introduction: The most important prognostic factor for breast cancer is tumour stage and tumour grade. However, the assessment of the above parameters are time-consuming and require expertise. Thus evaluation of the prognosis of breast cancer is still limited to tertiary care hospitals, with appropriate facilities for histopathological techniques. Recently, inflammatory blood markers have shown a role as a prognostic factor. Out of all the inflammatory blood markers, neutrophil-lymphocyte ratio has emerged as the most useful. Abundant evidence suggests the role of NLR as an adverse prognostic factor in breast cancer. NLR is simple and inexpensive. It can be easily obtained, as the differential count of every patient is done routinely. Thus it can act as an indicator of high-risk patients who are likely to show poor prognosis. Though NLR has been found to play a role in prognosis prediction in breast cancer, much is unknown in this field. Aim: To assess the effectiveness of Neutrophil-Lymphocyte Ratio (NLR) as an independent prognostic parameter among breast cancer patients in a tertiary care hospital in Kolkata, India. Materials and Methods: This observational cross-sectional study was conducted in Department of Pathology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India, where 140 female patients undergoing mastectomy for breast cancer were studied from 1st February 2019 to 31st January 2020. The clinicopathological parameters, histopathological parameters, and molecular subtypes were evaluated. NLR was calculated and related with the other prognostic parameters. Data entry was done in Microsoft Excel and analysis was done using Statistical Package for Social Sciences (SPSS) software version 20.0. One way Analysis of Variance (ANOVA) test and Chi-square test was conducted to assess the relationship of NLR with various other prognostic factors. Results: Out of 140 patients, 78 patients showed NLR values within 1.8 to 3.33. Higher NLR (>3.33) was associated with poor prognostic factors like higher T stage (T4) {17 (53.1%)}, higher stage (stage III) 95 (67.8%), skin involvement 19 (47.5%), Lymphovascular involvement in 23 (39.7%), perineural involvement in 10 (71.4%) and in patients with HER2 positive molecular subtype in 8 (5.7%). Conclusion: This study suggests that a high NLR value was associated with poor prognosis in breast cancer patients. Thus, it can be used as an independent marker of poor prognosis and can help guide the treatment of breast cancer patients. The more we study the role of NLR, the more useful it will be in predicting the course of breast cancer as early as possible.