Abstract
BackgroundThe aim of this study was to determine the utility of the neutrophil-to-lymphocyte ratio (NLR) as a biomarker for predicting early-mortality (<2 years) among females with metastatic triple-negative breast cancer (mTNBC).MethodsWe reviewed 118 medical records of females with mTNBC. The cut-off value for the NLR (<2.5 and ≥2.5) was determined with receiver operating characteristic curves (area under the curve: 0.73; 95% CI: 0.62–0.85). Survival curves were estimated using the Kaplan-Meier method and compared with the Log-rank test. Multivariate Cox regression was used to identify the risk of mortality at two years. Moreover, we performed sensitivity analyses with different cut-off values and a subgroup analysis in females that only received chemotherapy.ResultsThe median follow-up was 24 months. Females with NLR ≥2.5 had a poor overall survival compared to females with NLR <2.5 (6% vs. 28%, p<0.001) at two years. This outcome remained when we stratified for females that only received chemotherapy (8% vs. 36%, p = 0.001). Multivariate analyses identified NLR ≥2.5 as a poor prognostic risk factor for mortality in the entire population (HR: 2.12, 95% CI: 1.32–3.39) and among females that received chemotherapy (HR: 2.68, 95% CI: 1.46–4.92).ConclusionThe NLR is an accessible and reliable biomarker that predicts early mortality among females with mTNBC. Our results suggest that females with high NLR values have poor prognosis despite receiving standard chemotherapy. Health providers should evaluate the possibility to enroll these patients in novel immunotherapy trials.
Highlights
Triple-negative breast cancer (TNBC) is a heterogeneous and aggressive subtype of breast cancer
Multivariate analyses identified neutrophil-to-lymphocyte ratio (NLR) 2.5 as a poor prognostic risk factor for mortality in the entire population (HR: 2.12, 95% confidence intervals (CI): 1.32–3.39) and among females that received chemotherapy (HR: 2.68, 95% CI: 1.46–4.92)
Our results suggest that females with high NLR values have poor prognosis despite receiving standard chemotherapy
Summary
Triple-negative breast cancer (TNBC) is a heterogeneous and aggressive subtype of breast cancer. In contrast to other subtypes, females with TNBC have worse survival outcomes and the only available systemic treatment is chemotherapy [1, 2] Despite these poor outcomes and restricted treatment alternatives, few authors have studied effective biomarkers to predict survival prognosis in Latin American countries [3,4,5,6]. Other studies identified favorable survival outcomes in females with a high concentration of lymphocytes in breast cancer [9, 10] For this reason, the neutrophil-to-lymphocyte ratio (NLR) has demonstrated to be a useful biomarker to predict survival outcomes in breast cancer [11,12,13]. The aim of this study was to determine the utility of the neutrophil-to-lymphocyte ratio (NLR) as a biomarker for predicting early-mortality (
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