Abstract
Inflammatory blood markers (IBM), such as the neutrophil to lymphocyte ratio (NLR), have emerged as potential prognostic factors in various cancers, including breast cancer (BC), potentially allowing an easy, minimally invasive evaluation of a given cancer‘s prognosis and treatment outcome. We report here a systematic overview of the published data evaluating NLR as a prognostic factor or predictive factor for pathological complete response (PCR) and toxicity in early and advanced BC. A total of 45 articles were identified. NLR was found to be an independent prognostic factor for survival in most of the adjuvant treatment studies. However, no significant correlation was found between survival and NLR for early BC patients receiving neo-adjuvant chemotherapy (NACT) and advanced BC patients. Most studies failed to find a significant correlation between NLR and PCR after NACT. Finally, some data showed that IBM could be predictive of chemotherapy-related toxicity.
Highlights
IntroductionBreast cancer (BC) prognosis depends on the tumor stage (localized versus metastatic disease), and on the molecular subtype (luminal, HER2+, or triple-negativebreast cancer (BC))
Breast cancer (BC) prognosis depends on the tumor stage, and on the molecular subtype
Sub Group Analyses: Asano et al [23] showed that in the subgroup of patients with triple negative BC (TNBC) (n = 61), neutrophil to lymphocyte ratio (NLR) was correlated with disease-free survival (DFS) in the univariate analysis, but was not an independent prognostic factor of DFS
Summary
Breast cancer (BC) prognosis depends on the tumor stage (localized versus metastatic disease), and on the molecular subtype (luminal, HER2+, or triple-negativeBC). Some predictive and/or prognostic factors are available (for example, hormone receptor status, HER2 overexpression/amplification, histological grade or stage), additional predictive and prognostic biomarkers are needed to better adapt the treatment to each individual patient. Lymphopenia and a high NLR before chemotherapy initiation have been inconsistently associated with worse responses to neo-adjuvant chemotherapy and with poor prognoses of different cancer types, including BC [3,4]. The role of inflammation in cancer is well established [5], and has been described at different stages of cancer development (initiation, promotion, invasion, and metastasis). Activated inflammatory cells are sources of reactive oxygen species and reactive nitrogen intermediates that can induce DNA damage and genome instability, promoting cancer initiation [6,7], or interfere with the DNA repair systems [8]. Inflammation increases the production of growth factors and cytokines that can Cancers 2020, 12, 958; doi:10.3390/cancers12040958 www.mdpi.com/journal/cancers
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