Abstract
PurposeThis study was determined to evaluate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein/albumin ratio (CAR) prior to surgery in luminal breast cancers (BC) with HER2-negativity.MethodsThe clinical data of 708 HER2-negative luminal BC patients from January 2013 to December 2016 were retrospectively collected and analyzed. The optimal cut-off value of NLR and CAR were determined via receiver operating characteristic (ROC) curve. The disease-free survival (DFS) and cancer specific survival (CSS) rates were estimated using the Kaplan−Meier method. Cox univariate and multivariate proportional hazards regression models were performed to identify significant predictors of DFS and CSS simultaneously.ResultsThe mean age of the patients diagnosed was 52.43 years (range, 15–95 years), and the median follow-up was 62.71 months (range, 12-92 months). Univariate and multivariate analysis confirmed that NLR ≥2.2 was significantly associated with worse DFS (HR=2.886, 95%CI=1.756-4.745, p<0.001), and same results were obtained in terms of CSS (HR=3.999, 95%CI=2.002-7.987, p<0.001). Similarly, CAR ≥0.07 was independently and significantly associated with poor DFS (HR=3.858, 95%CI=2.346-6.345, p<0.001) and CSS (HR=6.563, 95%CI=3.558-12.106, p<0.001).ConclusionPreoperative evaluation of NLR and CAR were significant and independent prognostic indicators for luminal breast cancers with HER2-negativity.
Highlights
Breast cancer (BC) is the most commonly diagnosed malignancy in women worldwide [1], with an estimated 20.9 million new cases and 626,679 deaths in 2018 [2]
Univariate and multivariate analysis confirmed that neutrophil-to-lymphocyte ratio (NLR) ≥2.2 was significantly associated with worse disease-free survival (DFS) (HR=2.886, 95%CI=1.756-4.745, p
We identified 918 patients who completed the treatment of luminal BC with HER2-negativity, and 708 patients were eligible for analysis
Summary
Breast cancer (BC) is the most commonly diagnosed malignancy in women worldwide [1], with an estimated 20.9 million new cases and 626,679 deaths in 2018 [2]. Inflammatory parameters such as neutrophil-to-lymphocyte ratio (NLR), platelet−tolymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), C-reactive protein/albumin ratio (CAR) and Glasgow Prognostic Score (GPS) have been reported as useful indicators for predicting the prognosis of various solid cancers, including BC [6–10]. In the most recent meta-analyses [11, 12], high NLR predicted poorer OS and DFS in BC patients, especially in triple-negative breast cancer (TNBC) patients. On the contrary, Ding et al [14] found that NLR did not have prognostic value among HER-2+ patients without trastuzumab treatment, yet could predict the prognosis of those who received trastuzumab treatment for 1 year. The 3-year DFS of the low NLR group was found to be significantly higher than that of the high NLR group (95.3% vs 90.5%, P=0.011). The majority of studies focused on the correlation between NLR and HER2-positive BC, whereas only a minority of studies investigated the possible predictive role of NLR in luminal BC with HER2-negativity [15, 16]
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