Abstract
BackgroundThere is a growing body of evidence that immune response plays a large role in cancer outcome. The neutrophil to lymphocyte ratio (NLR) has been used as a simple parameter of systemic inflammation in several tumors. The purpose was to investigate the association between pre-treatment NLR, disease-free survival and overall survival in patients with early triple negative breast cancer (TNBC).MethodsWe reviewed the records of patients with stage I-III TNBC at our Institution from 2006 to 2012. The association between pre-treatment NLR and survival was analyzed. The difference among variables was calculated by chi-square test. DFS and OS were estimated using Kaplan-Meier method. Cox analysis was performed to analyze clinical parameters for their prognostic relevance.ResultsA total of 90 patients were eligible. There was no significant correlation among pre-treatment NLR and various clinical pathological factors. Patients with NLR higher than 3 showed significantly lower DFS (p = 0.002) and OS (p = 0.009) than patients with NLR equal or lower than 3. The Cox proportional multivariate hazard model revealed that higher pre-treatment NLR was independently correlated with poor DFS and OS, with hazard ratio 5.15 (95% confidence interval [CI] 1.11-23.88, p = 0.03) and 6.16 (95% CI 1.54-24.66, p = 0.01) respectively.ConclusionOur study suggests that pre-treatment NLR may be associated with DFS and OS patients with early TNBC. Further validation and a feasibility study are required before it can be considered for clinical use.
Highlights
There is a growing body of evidence that immune response plays a large role in cancer outcome
The Cox proportional multivariate hazard model revealed that higher pre-treatment neutrophil to lymphocyte ratio (NLR) was independently correlated with poor disease-free survival (DFS) and overall survival (OS), with hazard ratio 5.15 (95% confidence interval [confidence intervals (CIs)] 1.11-23.88, p = 0.03) and 6.16 respectively
We investigated the prognostic role of pre-treatment NLR in triple negative breast cancer (TNBC) subtype and our study suggests that increased pre-treatment NLR may be associated with worse DFS and OS in patients with early TNBC
Summary
There is a growing body of evidence that immune response plays a large role in cancer outcome. The purpose was to investigate the association between pre-treatment NLR, disease-free survival and overall survival in patients with early triple negative breast cancer (TNBC). Triple negative breast cancer (TNBC) represents approximately 10–20% of breast cancers and they are defined by the absence of estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 expression. Recurrence and disease progression are relatively common for women with TNBC, with a peak risk of recurrence within the first three-five years after diagnosis. A large tumour size, nodal involvement and poor clinical outcomes for women with TNBC may in part be explained by intrinsically aggressive tumour pathology, Owing to the aggressive tumor biology and lack of targeted therapy, TNBC is characterized by a dismal heterogeneous outcome. In 2011, Lehman et al analysed gene expression (GE) profiles identifying 587 TNBC cases. Cluster analysis identified 6 TNBC subtypes displaying unique GE and ontologies, including 2 basal-like (BL1 and BL2), an immunomodulatory (IM), a mesenchymal (M), a mesenchymal stem–like (MSL), and a luminal androgen receptor (LAR) subtype [3]
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