Prognostic Relevance of Neutrophil to Lymphocyte Ratio (NLR) in Luminal Breast Cancer: A Retrospective Analysis in the Neoadjuvant Setting.

Antonino Grassadonia,Nicola Tinari,Clara Natoli,Laura Iezzi,Patrizia Vici,Maddalena Barba,Vincenzo Graziano,Giuseppe Cicero,Laura Pizzuti,Antonella Amodio,Eriseld Krasniqi,Daniele Marinelli,Marco Mazzotta

doi:10.3390/cells10071685

Abstract

The neutrophil to lymphocyte ratio (NLR) is a promising predictive and prognostic factor in breast cancer. We investigated its ability to predict disease-free survival (DFS) and overall survival (OS) in patients with luminal A- or luminal B-HER2-negative breast cancer who received neoadjuvant chemotherapy (NACT). Pre-treatment complete blood cell counts from 168 consecutive patients with luminal breast cancer were evaluated to assess NLR. The study population was stratified into NLRlow or NLRhigh according to a cut-off value established by receiving operator curve (ROC) analysis. Data on additional pre- and post-treatment clinical-pathological characteristics were also collected. Kaplan–Meier curves, log-rank tests, and Cox proportional hazards models were used for statistical analyses. Patients with pre-treatment NLRlow showed a significantly shorter DFS (HR: 6.97, 95% CI: 1.65–10.55, p = 0.002) and OS (HR: 7.79, 95% CI: 1.25–15.07, p = 0.021) compared to those with NLRhigh. Non-ductal histology, luminal B subtype, and post-treatment Ki67 ≥ 14% were also associated with worse DFS (p = 0.016, p = 0.002, and p = 0.001, respectively). In a multivariate analysis, luminal B subtype, post-treatment Ki67 ≥ 14%, and NLRlow remained independent prognostic factors for DFS, while only post-treatment Ki67 ≥ 14% and NLRlow affected OS. The present study provides evidence that pre-treatment NLRlow helps identify women at higher risk of recurrence and death among patients affected by luminal breast cancer treated with NACT.

Highlights

Breast cancer is the second cause of cancer death in women in industrialized countries, despite early diagnoses and therapeutic advances having considerably reduced mortality [1]
This latter aspect is important for triple-negative (TN) or human epidermal growth factor receptor 2 (HER2)-positive breast cancer, since patients who do not achieve a pathological complete response following Neoadjuvant chemotherapy (NACT) have a dismal prognosis [2,3]
We identified 168 patients with luminal breast cancer who had received NACT and with a pre-treatment complete blood cell count reported in our clinical records

Summary

Introduction

Breast cancer is the second cause of cancer death in women in industrialized countries, despite early diagnoses and therapeutic advances having considerably reduced mortality [1]. Neoadjuvant chemotherapy (NACT) is the standard of treatment in locally advanced breast cancer, but in recent years it has been widely used in operable tumors to allow breast-conserving surgery (BCS), and to test in vivo tumor responsiveness to chemotherapy This latter aspect is important for triple-negative (TN) or human epidermal growth factor receptor 2 (HER2)-positive breast cancer, since patients who do not achieve a pathological complete response (pCR) following NACT have a dismal prognosis [2,3]. In these cases, further adjuvant chemotherapy can significantly improve long-term outcomes [4,5,6].

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