Abstract
Background: Chemotherapy-induced febrile neutropenia (FN) is a condition affecting mortality and morbidity. The records show that absolute neutrophil-to-lymphocyte ratio (NLR) is associated with the cancer prognosis and reflects the immune response system on the infection. It can be used as an independent prognostic biomarker and predictive marker in patients with chronic inflammatory diseases, cardiovascular diseases, or malignancies. Therefore, we have been conducted on using absolute NLR to predict FN in a patient with breast cancer who has adjuvant chemotherapy. Materials and Methods: The authors retrospectively evaluated the pretreatment absolute NLR of patients with early stage breast cancer who had adjuvant chemotherapy. Then, the relationship to FN was analyzed by using multivariate logistic regression analysis. Results: We conducted a retrospective analysis of 339 patients where 21 patients had developed FN (6.19%). The multivariate logistic regression analysis results indicated that the pretreatment absolute NLR cut-off point equal to or greater than 2.4 was a significant independent predictive biomarker of the chemotherapy-induced FN (odds ratio = 2.810, 95%,; CI 1.061 - 7.442; p = 0.038). The predictive performance of the high level of absolute NLR was an acceptable discrimination [AUC= 0.7626 (95% and CI 0.650 - 0.875)]. Furthermore, a calibration curve and the Hosmer-Lemeshow test to assess the accuracy of the predictive model showed a goodness of fit for a logistic predictive model (Hosmer-Lemeshow chi2 = 2.50; p = 0.645). Conclusions: Pretreatment absolute NLR would be a useful predictive biomarker for febrile neutropenia after the first cycle of adjuvant chemotherapy for breast cancer that would be simple and easy to integrate in daily practice without extra costs.
Highlights
Breast cancer is the most commonly found disease in Thai females
Exclusion criteria included 1) stage IV breast cancer, 2) a history of other cancers, 3) unavailable essential data, 4) a history of anemia or other hematological disorders, 5) renal and hepatic impairment, 6) the first chemotherapy cycle was not administered at this hospital, and 7)a prophylactic use of granulocyte-colony stimulating factor (G-CSF)
When analyzing the pretreatment absolute neutrophil-to-lymphocyte ratio (NLR), which was related to febrile neutropenia (FN), there was the risk of FN at 1.693 times (Table 3)
Summary
Breast cancer is the most commonly found disease in Thai females. According to the National Cancer Institute of Thailand, there were 40.8% new patients in 2018 [1]. The records show that absolute neutrophil-to-lymphocyte ratio (NLR) is associated with the cancer prognosis and reflects the immune response system on the infection It can be used as an independent prognostic biomarker and predictive marker in patients with chronic inflammatory diseases, cardiovascular diseases, or malignancies. The multivariate logistic regression analysis results indicated that the pretreatment absolute NLR cut-off point equal to or greater than 2.4 was a significant independent predictive biomarker of the chemotherapy-induced FN (odds ratio = 2.810, 95%,; CI 1.061 - 7.442; p = 0.038). Conclusions: Pretreatment absolute NLR would be a useful predictive biomarker for febrile neutropenia after the first cycle of adjuvant chemotherapy for breast cancer that would be simple and easy to integrate in daily practice without extra costs
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